Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study

Bo Wu; Xiang Zhang; Nan Feng; Zhuozheng Hu; Jiajun Wu; Weijun Zhou; Yiping Wei; Wenxiong Zhang; Kang Wang

doi:10.1371/journal.pone.0298470

Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study

PLoS One. 2024 Apr 29;19(4):e0298470. doi: 10.1371/journal.pone.0298470. eCollection 2024.

Authors

Bo Wu¹, Xiang Zhang¹, Nan Feng¹, Zhuozheng Hu¹, Jiajun Wu¹, Weijun Zhou¹, Yiping Wei¹, Wenxiong Zhang¹, Kang Wang²

Affiliations

¹ Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
² Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.

Abstract

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.

Copyright: © 2024 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung* / mortality
Carcinoma, Non-Small-Cell Lung* / pathology
Carcinoma, Non-Small-Cell Lung* / therapy
Combined Modality Therapy
Female
Humans
Lung Neoplasms* / mortality
Lung Neoplasms* / pathology
Lung Neoplasms* / therapy
Male
Middle Aged
Neoplasm Staging*
SEER Program*
Survival Analysis

Grants and funding

This study was funded by the National Natural Science Foundation of China 81560345, to WZ and Natural Science Foundation of Jiangxi Province, 20212BAB206050, to WZ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.