Yang CFJ, et al. - A national analysis was undertaken to evaluate outcomes associated with surgery in stage IV non-small cell lung cancer (NSCLC). Surgery for cT1-2N0-1M1 or cT3N0M1 disease seemed correlated with a 5-year survival of 25% and does not appear to compromise outcomes when compared to non-operative therapy, supporting guidelines that recommend surgery for very select patients with stage IV disease. However, researchers observed less benefit with surgery and recommended considering surgery much less often for stage IV patients with mediastinal nodal disease or more locally advanced tumors.

Methods

• The National Cancer Date Base (2004-2013) was analyzed for factors associated with survival of stage IV NSCLC patients treated with surgery using multivariable Cox proportional hazard analyses.
• Researchers evaluated outcomes of the subset of patients with cT1-2N0-1M1 and cT3N0M1 disease treated with surgery or chemoradiation using Kaplan-Meier analyses.

Results

• In this study, stage IV NSCLC patients who underwent surgical resection (n = 3098) had the five-year survival of 21.1%.
• Outcomes seemed associated with the locoregional extent of the primary tumor, as worse survival was evident with both increasing T status (T2 HR 1.30 [p < 0.001], T3 HR 1.28 [p < 0.001], and T4 HR 1.28 [p < 0.001] respectively compared to T1) and nodal involvement (N1 HR 1.34 [p < 0.001], N2 HR 1.50 [p < 0.001], and N3 HR 1.49 [p < 0.001] respectively compared to N0).
• Furthermore, there appeared an association of outcomes with the extent of surgical resection, as pneumonectomy (HR 1.58, p < 0.001), segmentectomy (HR 1.36, p=0.009), and wedge resection (HR 1.70, p < 0.001) were all associated with decreased survival when compared to lobectomy.
• cT1-2N0-1M1 and cT3N0M1 patients had five-year survival of 25.1% (95% CI:22.8-27.5) after surgical resection (n = 1761) and 5.8% (95% CI:5.2-6.5) after chemoradiation (n = 8180).