Do older patients with stage IB non-small-cell lung cancer obtain survival benefits from surgery? A propensity score matching study using SEER data

Abstract

BackgroundSurgical 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. MethodsData 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. ResultsAfter 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. ConclusionsOlder 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.