Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, Jiangsu, 226001, China.
Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University (Beijing Tuberculosis and Thoracic Tumor Research Institute), Beijing, 101149, China.
Eur J Surg Oncol. 2022 Sep;48(9):1954-1963. doi: 10.1016/j.ejso.2022.03.015. Epub 2022 Mar 21.
Surgical resection is the preferred treatment for Stage IB non-small cell lung cancer (NSCLC), but one-third of patients still do not receive surgery, which might be due to the lack of robust and dedicated studies on the outcomes of surgical treatment in older patients with stage IB NSCLC. This study aims to investigate whether older patients with stage IB NSCLC benefit from surgery.
Data of patients with NSCLC were downloaded from the SEER (Surveillance, Epidemiology, and End Results) database classifications were converted from the 7th edition staging system to the 8th edition staging system, and older patients (aged ≥65 years at diagnosis) with stage IB NSCLC were included. The propensity score matching (PSM) method was used to balance the distribution proportions of clinical characteristics between the surgery and no surgery groups.
After 1:1 propensity score matching, the distribution proportions of clinical characteristics were balanced between the surgery and no surgery groups (all P > 0.05). The overall and disease-specific survival rates of patients in the surgery group were significantly higher than those of patients in the no-surgery group (both P < 0.001). Furthermore, subgroup analysis showed that receiving surgery was a protective factor for overall survival and disease-specific survival of patients in all clinical character-related subgroups. Ultimately, univariate and multivariate Cox regression analyses showed that sex, tumor size, tumor grade, and tumor classification were independent prognostic factors for overall and disease-specific survival in patients undergoing surgery.
Older patients with Stage IB NSCLC can benefit significantly from surgical treatment after eliminating confounding factors, which is expected to provide strong medical evidence for surgical treatment.
手术切除是治疗 I B 期非小细胞肺癌（NSCLC）的首选方法，但仍有三分之一的患者未接受手术治疗，这可能是因为缺乏针对 I B 期 NSCLC 老年患者手术治疗结果的强有力且专门的研究。本研究旨在探讨 I B 期 NSCLC 老年患者是否从手术中获益。
从 SEER（监测、流行病学和最终结果）数据库下载 NSCLC 患者的数据，将分类从第 7 版分期系统转换为第 8 版分期系统，并纳入 I B 期 NSCLC 且年龄≥65 岁的老年患者。采用倾向评分匹配（PSM）方法平衡手术组和非手术组之间的临床特征分布比例。
经过 1:1 倾向评分匹配后，手术组和非手术组之间的临床特征分布比例得到平衡（均 P>0.05）。手术组患者的总生存率和疾病特异性生存率明显高于非手术组（均 P<0.001）。此外，亚组分析显示，对于所有与临床特征相关的亚组患者，接受手术是总生存率和疾病特异性生存率的保护因素。最终，单因素和多因素 Cox 回归分析显示，性别、肿瘤大小、肿瘤分级和肿瘤分类是手术患者总生存率和疾病特异性生存率的独立预后因素。
在消除混杂因素后，I B 期 NSCLC 老年患者可从手术治疗中显著获益，这有望为手术治疗提供有力的医学证据。
