Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients

Abstract

Surgical intervention for stage IV non-small cell lung cancer (NSCLC) is still controversial. This study sought to evaluate the clinical effects of surgical intervention on survival in patients with stage IV NSCLCs and to identify the cohort benefitting the most from surgery.A retrospective study from the Surveillance, Epidemiology, and End Results database was performed to compare the survival of stage IV NSCLC patients who had undergone surgery with those who did not undergo surgery. Overall survival (OS) was evaluated using the Kaplan–Meier method and the log-rank test. The Cox proportional hazards model was used for multivariate analysis.The total number of eligible patients was 43,538, including 16.8% in the M1a stage and 83.2% in the M1b stage. The percentages of patients with no surgery (NONE), only metastatic tumor resection (MTR), only primary tumor resection (PTR), and both primary and metastatic tumor resection (PMTR) were 89.0%, 6.7%, 3.5%, and 0.8%, respectively; the corresponding 5-year survival rates were 2.0%, 4.0%, 13.0%, and 20.0%, respectively (P < 0.001); and the corresponding OS rates were 11.1 months, 14.7 months, 29.4 months, and 34.9 months, respectively (P < 0.001). Notably, the pairwise comparisons of 5-year survival rate and OS among the subgroups were all statistically significant. The multivariate analysis showed that surgical intervention was correlated with longer survival in patients with stage IV NSCLC. The stratified analysis showed significant differences in the OS on strata of the M1a stage and strata of the M1b stage. In the M1a stage, patients with PTR had significantly better OS than those with NONE (P < 0.001) or MTR (P < 0.001) but showed no significant differences compared with those with PMTR (P = 0.174); patients with MTR did not have prolonged survival compared with patients with NONE (P = 0.185), and they also did not have prolonged survival compared with patients with PMTR (P = 0.052). In the M1b stage, pairwise comparisons of OS were all statistically significant among the subgroups (P < 0.001).Surgical intervention can prolong survival to different degrees according to the modalities of surgery in stage IV NSCLC.

Construction of a nomogram predicting the overall survival of patients with distantly metastatic non-small-cell lung cancer

“…Marital status, sex, race, age, histology, T stage, N stage, histological differentiation, the presence of bone metastasis, brain metastasis, liver metastasis, M1a disease, surgery of primary cancer, and chemotherapy were identified as the prognostic factors of the OS, which was in line with the previous studies. 5 , 7 , 8 , 11 , 16 – 18 Among them, surgery of primary cancer could notably improve the prognosis. Thus, we analyzed the characteristics of these patients who underwent surgery and found that all of them received radiation therapy, and most of them received chemotherapy.…”

“…In reality, metastatic lung cancer is a heterogeneous disease with various prognoses, 3 which are affected by physical conditions of patients, such as age, sex, marital status, performance status as well as the TN stage, pathological or genotype characteristics, type of metastatic organ, number of metastatic sites, and medical treatments. 2 – 8 Estimating prognosis of every patient accurately may benefit patients and doctors alike in all aspects of decision-making. 9 The TNM stage released by International Association for the Study of Lung Cancer International Staging Project is widely accepted as a tool to predict the prognosis of patients and had been updated to the eighth edition.…”

miR-138 suppresses the proliferation, metastasis and autophagy of non-small cell lung cancer by targeting Sirt1

“…Lung cancer is mainly classified into two tissue subtypes as non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for ~80% of lung cancer, including adenocarcinoma, squamous cell carcinoma and large cell carcinoma ( 4 ). Currently, surgical resection combined with chemotherapy and radiotherapy is still the main means of clinical treatment for lung cancer.…”

Oridonin enhances the radiosensitivity of lung cancer cells by upregulating Bax and downregulating Bcl‑2

“…In recent years, great progress has been made in the diagnosis of and clinical therapy for lung cancer. However, the mortality rate of patients with lung cancer remains high, with a 5-year survival rate of only 15% (25)(26)(27). Oridonin is a compound that is extracted from the traditional Chinese herb R. rubescens, which possesses anticancer properties through inhibiting proliferation and promoting apoptosis (24,28,29).…”