Abstract
BACKGROUND: Few studies have focused on the role of surgery in the treatment of stage IV non-small cell lung cancer (NSCLC). In our study, we mainly focused on the surgical therapeutic option for NSCLC patients with American Joint Committee on Cancer stage IV. PATIENTS AND METHODS: Using the Surveillance Epidemiology and End Results database, we screened out an appropriate patient population with stage IV NSCLC treated between 2004 and 2013. Kaplan-Meier curve analysis was used to compare the survival between patients receiving surgery and standard of care. The effect of surgery on primary and regional/distant sites on overall survival (OS) was further evaluated by Cox proportional hazard model. Finally, subgroup analysis based on patient and disease variables was conducted by Cox proportional hazard and presented as a forest plot. RESULTS: A total of 61,418 stage IV NSCLC patients were enrolled. However, only 11.6% received local surgical treatment. Surgery to primary and regional/distant sites were both independent prognostic factors of OS (P<0.001). Survival advantage was identified in those patients who received surgery to primary sites for all subgroup variables (P<0.001). However, survival benefit was not demonstrated for patients with surgery to regional/distant sites in some subgroup variables, including black racial background, squamous cell carcinoma, large cell carcinoma, and N1 staging (all, P>0.1). Importantly, we observed that surgery of primary tumor sites at stage N0 showed the maximum OS benefit (P<0.001). CONCLUSION: These findings about N staging and primary tumor site treatment should be taken into consideration by surgeons when determining the suitability of surgery for stage IV NSCLC patients.