Outcomes of Surgery as Part of the Management of Metastatic Non–Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results Database Analysis

The role of local treatment in patients with oligometastatic non–small-cell lung cancer (NSCLC) is a subject of ongoing debate. This study assessed the survival impact of combined surgery to the primary tumor and metastatic disease in the management of metastatic NSCLC. Stage IV NSCLC patients at presentation, diagnosed from 2004 to 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. Propensity-matched analysis was performed considering baseline characteristics (age, gender, race, histology, TN stage, and site of metastases). A total of 144,334 patients were identified. The median age group was 65–70 years, and 1139 patients (0.8% of the patients) have received surgical treatment to both the primary tumor and metastatic disease. Both before and after propensity score matching, cancer-specific and overall survival were better in the surgical therapy group (P < 0.0001 for all). When the analysis was restricted to the subsets of patients with brain only M1 disease or isolated contra lateral nodule, overall survival was improved by combined surgery. However, in multivariate analysis of the overall population (postmatching), combined surgery was not associated with a better overall survival (0.576). Despite the apparently beneficial role of surgery in this study for some patients with metastatic disease, the absence of adequate information about systemic therapy as well as associated comorbidity hinders the generation of definite conclusions. Prospective studies are needed to confirm the role of surgery in the setting of metastatic disease.

寡转移性非小细胞肺癌（non-small-cell lung cancer, NSCLC）患者的局部治疗作用，至今仍是学界持续争论的热点议题。本研究针对转移性非小细胞肺癌的诊疗方案，评估了原发肿瘤与转移灶联合手术治疗对患者生存结局的影响。本研究从监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库中，筛选出2004年至2013年间确诊的初诊IV期非小细胞肺癌患者。研究基于患者基线特征（年龄、性别、种族、组织学类型、TN分期及转移部位）开展倾向得分匹配分析。最终共纳入144334例患者，其中位年龄区间为65~70岁；仅1139例患者（占总人群的0.8%）接受了原发肿瘤与转移灶联合手术治疗。无论倾向得分匹配前后，联合手术治疗组的癌症特异性生存率与总生存率均显著更优（所有指标P<0.0001）。当分析限定于仅脑转移M1期患者或孤立性对侧结节转移患者亚组时，联合手术治疗可显著改善患者总生存率。然而，对匹配后全人群进行多因素分析时，联合手术治疗并未与更优的总生存率显著相关（P=0.576）。尽管本研究显示手术对部分转移性非小细胞肺癌患者存在潜在获益，但由于缺乏系统治疗及合并症的详细数据，本研究无法得出确定性结论。未来仍需开展前瞻性研究，以明确手术在转移性非小细胞肺癌诊疗中的应用价值。