Open AccessSurvival value of primary tumour resection for stage IV non–small‐cell lung cancer: A population‐based study of 6466 patients
Author(s) -
Xu Jing,
Fan Lulu,
Yu Hanqing,
Lu Donghui,
Peng Wanren,
Sun Guoping
Publication year - 2020
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.13194
Subject(s) - medicine , nomogram , stage (stratigraphy) , proportional hazards model , oncology , surveillance, epidemiology, and end results , lung cancer , lymph node , hazard ratio , survival analysis , epidemiology , population , cancer registry , confidence interval , paleontology , environmental health , biology
For stage IV non–small‐cell lung cancer (NSCLC) patients, surgical resection of primary tumour was rarely recommended. Objectives We conducted this population‐based study to demonstrate the survival value of primary tumour resection (PTR) for stage IV (NSCLC). Methods The Surveillance, Epidemiology and End Results (SEER) database was searched for selecting stage IV NSCLC patients. The patients were matched according to age, gender, grade, primary tumour site, histopathological type, tumour size and regional lymph nodes metastasis by propensity score matching (PSM) analysis. Kaplan‐Meier curves were presented to show the survival differences between resection group and non‐resection group. Risk factors which were supposed to influence survival outcome were investigated using a Cox proportional hazard regression model. And a nomogram was performed to present prognostic factors for stage IV NSCLC patients. Results 6466 patients diagnosed from 2004 to 2015 were included in survival analyses after PSM. The median overall survival (OS) for overall patients with resection was 27 months, much longer than those without resection (8 months). And this trend remained in subgroup analyses, including different histopathological types and distant metastases (All P values < 0.001). Younger age, race other than white and black, female, grade 1/2 (G1/G2), PTR, chemotherapy, no other distant metastases, smaller tumour size and no regional lymph node metastases were favourable prognostic factors for stage IV NSCLC. A predictive nomogram was conducted based on above risk factors. Conclusion PTR prolonged survival of stage IV NSCLC patients. And PTR should be considered in clinical practice for stage IV NSCLC.