Abstract
Surgery is usually not indicated in far advanced stage non-small cell lung cancer (NSCLC), but a few recent clinical trials demonstrated aggressive local therapy such as (chemo) radiotherapy or surgical resection improved survival outcomes in oligometastatic NSCLC. This study aimed to evaluate survival impact of cytoreductive surgery in stage IIIB-IVA (based on the 8th TNM classification) NSCLC in the era of effective anticancer drugs. Patients with stage IIIB, IIIC or IVA NSCLC was recruited from the Hallym Lung Cancer Registry for this retrospective analysis. Other eligibility criteria were ECOG performance 0-1, age under 85 years old and good adherence to lung cancer treatment. A total of 203 patients were analyzed. All the patients received adequate anticancer drugs during their disease courses. Twenty-two patients (10.8%) received cytoreductive surgery. Significantly better overall survival (OS) was observed in surgery group compared with non-surgery group; Kaplan-Meier estimation for OS was 33.1 months [95% CI, 15.6-50.6] vs. 16.6 months [14.0-19.2] (p=0.007). The Cox proportional hazard ratio (HR) for death was 0.528 [0.290-0.961] (p=0.037) in surgery group when it was analyzed with covariates such as age, sex, performance, histology, stage, and smoking status. ECOG performance 0 and adenocarcinoma histology were also revealed as independent favorable prognostic factors for OS (HR .0.660 [0.474-0.919], p=0.014 and HR 0.481 [0.328-0.707], p<0.001, respectively). Surgery backed up with adequate anticancer treatments may be a treatment option in far advanced stage NSCLC.
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