Surgery and Surgery Approach Affect Survival of Patients With Stage I-IIA Small-Cell Lung Cancer: A Study Based SEER Database by Propensity Score Matching Analysis

Frontiers in Surgery

article

Xiaolu Chen¹  Jia-Li Zhu²  Huaying Wang¹  Wanjun Yu¹  Tao Xu¹ 

[1] Department of Respiratory and Critical Care, The Affiliated People's Hospital of Ningbo University;School of Medicine, Tongji University

关键词: small cell lung cancer;    I-IIA;    surgery;    SEER database;    propensity score matching;   

DOI  :  10.3389/fsurg.2022.735102

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Purpose The purpose of this study was to observe the significance of surgery and its approach in stage I-IIA (according to 8th American Joint Committee on Cancer Staging Manual) small-cell lung cancer (SCLC) using the Surveillance, Epidemiology, and End Results (SEER) database. Patients and Methods A total of 1,421 patients from ages 31 to 93 years who were diagnosed with stage I-IIA SCLC in the SEER database from 2010 to 2015 were analyzed. The 1:1 propensity score matching analysis was used to minimize the effect of selection bias, and 355 pairs of patients' data was performed subsequent statistical analysis. K–M analysis and a Cox proportional hazards model were used to observe the role of surgery and other clinical features in the patients' prognoses on cancer-specific survival (CSS). Results Overall, within the whole cohort, the 3- and 5-year CSS rates were 41.0 and 34.0%, respectively. In a Cox regression that adjusted for other clinical features, patients were more likely to benefit from the surgery [hazard ratio (HR) 0.292, 95% confidence interval (CI) 0.237–0.361, P < 0.001]. Unadjusted 5-year cancer-specific survival among those with surgery was 55.0%, compared with 23.0% among those without surgery. In the propensity scored-matched dataset, however, 5-year CSS among those with surgery was 54.0%, compared with 17.0% among those without surgery (HR 0.380, 95%CI 0.315–0.457, P < 0.001). In patients who received surgery, cases with lobectomy had a better 5-year CSS than those without lobectomy (65.0 vs. 39.0%). The lobectomy might be a protective factor for patients who underwent resection in CSS (HR 0.433, 95%CI 0.310–0.604, P < 0.001). Conclusions We suggested that the surgery and lobectomy were the independent prognostic as well as the protective factors in stage I-IIA SCLC patients. We recommended that patients with no surgical contraindications receive surgery, preferably, lobectomy.

【 授权许可】

CC BY