Abstract
BACKGROUND: Lung cancer remains the leading cause of death worldwide, yet optimal treatment strategies for octogenarians with early-stage non-small cell lung cancer (NSCLC) remain unclear. AIMS: To investigate treatment patterns and survival outcomes in octogenarians and older with early-stage NSCLC. METHODS: A retrospective cohort study was conducted using Surveillance, Epidemiology, and End Results database. Patients aged ≥ 80 years with stage I-IIA NSCLC diagnosed between 2011 and 2020 were included. Primary treatments included surgery, radiation, and no treatment. Kaplan-Meier curves were used to evaluate overall survival (OS) and cancer-specific survival (CSS) stratified by treatment and year. Propensity score matching balanced clinical characteristics between surgery and radiation groups, followed by Cox regression analysis. Survival outcomes were further compared within matched subgroups stratified by tumor size. RESULTS: Among 7,372 patients, median survival was 67 months for surgery and 33 months for radiotherapy. Radiotherapy use increased from 31.2% in 2011 to 49.4% in 2020, while surgery rates declined. Multivariate analysis (N = 2,434) showed radiotherapy was associated with worse OS (hazard ratio = 1.96, 95% CI = 1.78-2.15, P < 0.001) compared to surgery. DISCUSSION: Radiotherapy is increasingly used to treat early-stage NSCLC in octogenarians, yet surgery provides superior long-term survival. Limitations of lack of detailed comorbidity data and differentiation between conventional radiotherapy and stereotactic ablative radiotherapy (SABR) may have expanded the advantages of surgery. Meanwhile, patient performance status and preferences must be considered in treatment decisions. CONCLUSIONS: Surgery remains the preferred treatment option for eligible octogenarians with early-stage NSCLC.