Surgical Management of Advanced Non-Small Cell Lung Cancer Is Decreasing But Is Associated With Improved Survival

For patients with advanced stage non-small cell lung cancer (NSCLC), chemotherapy and chemoradiation are the principal treatment modalities, and the role of surgical resection remains unclear. Our objective was to evaluate current trends and oncologic outcomes for advanced stage NSCLC. We hypothesized that surgery is associated with increased survival and may be an underutilized treatment modality.

The California Cancer Registry was queried from 2004 to 2012 for cases of stage IIIA, IIIB, and IV NSCLC, and we identified 34,016 cases. Patients were categorized by treatment group, and linear regression was used to calculate trends in treatment and predictors of treatment group. Kaplan-Meier and Cox regression modeling were used to determine the influence of treatment group on overall survival.

Twenty-seven percent of patients (9,223 of 34,016) received no treatment. For the entire cohort, treatment with chemotherapy alone increased (p < 0.001), but treatment with radiation alone, surgery alone, or in any combination decreased (p = 0.011, p < 0.001, p = 0.021, p = 0.007, and p = 0.094). Treatment group, age, sex, race, socioeconomic status, stage, histology, and tumor size were all significant predictors of overall survival. Overall survival was significantly longer for patients who had surgery as part of their treatment regimen (p < 0.001).

For patients with advanced stage NSCLC, the use of multimodality regimens that include surgery are decreasing despite longer overall survival. Future studies are needed to identify the demographics and clinical characteristics of patients with advanced stage NSCLC who may benefit from surgery.