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Published on: February 12, 2017
Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study
Bo Wu1, Xiang Zhang1, Nan Feng1
1Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
Background:
There are various therapeutic methods for treating stage IA (T1N0M0) non-small cell lung cancer (NSCLC), but no studies have systematically assessed multiple treatments to determine the most effective therapy.
Methods:
Stage IA NSCLC patient data collected between 2004 and 2018 were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Treatment modalities included observation, chemotherapy alone (CA), radiation alone (RA), radiation+chemotherapy (RC), surgery alone (SA), surgery+chemotherapy (SC), surgery+radiation (SR) and surgery+radiation+chemotherapy (SRC). Comparisons were made of overall survival (OS) and lung cancer-specific survival (LCSS) among patients based on different therapeutic methods by survival analysis.
Results:
Ultimately, 89147 patients with stage IA NSCLC between 2004 and 2018 were enrolled in this study. The order of multiple treatment modalities based on the hazard ratio (HR) for OS for the entire cohort revealed the following results: SA (HR: 0.20), SC (HR: 0.25), SR (HR: 0.42), SRC (HR: 0.46), RA (HR: 0.56), RC (HR: 0.72), CA (HR: 0.91) (P<0.001), and observation (HR: Ref). The SA group had the best OS and LCSS, and similar results were found in most subgroup analyses (all P<0.001). The order of surgical modalities based on the HR for OS for the entire cohort revealed the following results: lobectomy (HR: 0.32), segmentectomy (HR: 0.41), wedge resection (HR: 0.52) and local tumor destruction (HR: Ref). Lobectomy had the best effects on OS and LCSS, and similar results were found in all subgroup analyses (all P<0.001).
Conclusion:
SA appeared to be the optimal treatment modality for patients with stage IA NSCLC, and lobectomy was associated with the best prognosis. There may be some indication and selection bias in our study, and the results of this study should be confirmed in a prospective study.
Insights
Surgery alone (SA) is the optimal treatment for stage IA non-small cell lung cancer (NSCLC), offering the best survival outcomes. Lobectomy, a specific surgical procedure, demonstrated the most favorable prognosis in this comprehensive analysis.
Area of Science:
- Oncology
- Thoracic Surgery
- Cancer Research
Background:
- Stage IA non-small cell lung cancer (NSCLC) presents diverse treatment options.
- A systematic comparison of these therapies to identify the most effective approach is lacking.
Purpose of the Study:
- To compare the effectiveness of various treatment modalities for stage IA NSCLC.
- To identify the optimal treatment strategy for improving overall survival (OS) and lung cancer-specific survival (LCSS).
Main Methods:
- Utilized data from 89,147 patients diagnosed with stage IA NSCLC between 2004 and 2018 from the SEER database.
- Employed survival analysis to compare overall survival (OS) and lung cancer-specific survival (LCSS) across treatment groups: observation, chemotherapy, radiation, and various surgical combinations.
- Analyzed surgical modalities including lobectomy, segmentectomy, wedge resection, and local tumor destruction.
Main Results:
- Surgery alone (SA) demonstrated the best OS and LCSS, with a hazard ratio (HR) of 0.20 compared to observation (Ref).
- Among surgical approaches, lobectomy showed the most significant survival benefit (HR: 0.32) compared to local tumor destruction (Ref).
- These findings were consistent across subgroup analyses, underscoring the efficacy of SA and lobectomy.
Conclusions:
- Surgery alone (SA) is identified as the optimal treatment for stage IA NSCLC.
- Lobectomy is associated with the best prognosis among surgical interventions for this patient group.
- Further prospective studies are recommended to validate these findings and address potential biases.
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