Abstract
A retrospective analysis was conducted on patients aged 60 and above with stage IV non-small cell lung cancer (NSCLC), in order to provide more evidence regarding the extension of the overall survival (OS) period of this patient group through surgical treatment. Patient data from the surveillance, epidemiology, and end results database between 2010 and 2015 were screened to identify cases with pathologically confirmed diagnoses of NSCLC. The inclusion criteria encompassed patients aged 60 years and above diagnosed with stage IV disease, as defined by the American Joint Committee on Cancer (AJCC) staging system. The eligible patients were categorized into surgical and non-surgical cohorts. A balanced comparison between the 2 cohorts was achieved through propensity score matching (PSM). Matching variables encompassed age, sex, race, marital status, tumor location, AJCC T stage, AJCC N stage, receipt of radiotherapy or chemotherapy, and the presence of distant metastases (bone, brain, lung, and liver). Kaplan-Meier analysis and multivariable Cox regression analysis were performed on the matched data to assess the effect of surgery on OS. To elucidate the potential benefits of surgical treatment across distinct patient populations, a detailed subgroup analysis was conducted including baseline variables between the surgical and non-surgical groups to accurately identify subgroups that benefit from surgical interventions. A total of 14,495 patients were included in the study, with 504 undergoing surgical intervention and 13,991 receiving non-surgical management. Following PSM, 1008 patients were successfully matched to establish balanced comparison groups. Multivariate Cox regression analysis revealed that surgical intervention was associated with a 54% reduction in mortality risk (hazard ratio = 0.46; 95% CI: 0.40-0.52; P <.001). Kaplan-Meier survival analysis demonstrated a significant advantage for the surgical group compared to the non-surgical group, with median OS of 21 months versus 7 months, respectively (P <.001). Subgroup analysis indicated that patients who did not undergo chemotherapy and those without lung metastases experienced greater survival benefit from surgical intervention. Unlike previous studies, this research specifically targets elderly patients diagnosed with stage IV NSCLC. The findings suggest that surgical intervention may enhance the prognosis in this cohort. Nevertheless, the decision to proceed with surgery must be based on a thorough assessment of the patient's clinical condition and comorbidities.