Definitive treatment patterns and survival in stage II non-small cell lung cancer

Lung Cancer. 2018 Oct:124:135-142. doi: 10.1016/j.lungcan.2018.07.035. Epub 2018 Jul 24.

Abstract

Objectives: This study delineated definitive treatment patterns for Stage II non-small cell lung cancer (NSCLC) in the United States and evaluated survival by treatment approach.

Materials and methods: Patients with clinically-staged Stage II NSCLC treated with surgery-based therapy, chemoradiation, conventionally-fractionated radiation (CFR), or stereotactic body radiotherapy (SBRT) were identified using the National Cancer Database (NCDB). Median survival was estimated using Kaplan-Meier analysis. Crude and adjusted hazard ratios (HR) and 95% confidence intervals were computed using Cox regression modeling.

Results: Between 2004-2012, 19,749 patients met study criteria: 13,382 (67.8%) underwent surgery-based treatment, 4,310 (21.8%) received chemoradiation, 1,606 (8.1%) received CFR, and 451 (2.3%) received SBRT. Surgery and SBRT utilization increased over time while CFR and chemoradiation decreased (all p ≤ 0.002). Patients receiving radiation-based treatments were older, with more comorbidities, and higher T/N stage (all p < 0.0001). With median follow-up of 25.2 months, median survival was 51.6, 23.3, 15.4, and 23.7 months for surgery-based treatment, chemoradiation, CFR, and SBRT, respectively (p < 0.0001). On multivariate analysis, chemoradiation (HR 1.67 [1.59-1.75], p < 0.0001), CFR (HR 2.38 [2.22-2.55], p < 0.0001), and SBRT (HR 1.76 [1.53-2.01], p < 0.0001) were associated with decreased survival versus surgery-based treatment. CFR was associated with decreased survival versus chemoradiation (HR 1.52 [1.41-1.63], p < 0.0001) and SBRT (HR 1.39 [1.19-1.61], p < 0.0001). SBRT was associated with similar survival versus chemoradiation (HR 1.10 [0.95-1.27], p = 0.212).

Conclusion: NCDB data demonstrate increasing use of surgery-based treatments and SBRT for Stage II NSCLC over time. Radiation-based therapies were associated with decreased survival compared to surgery. CFR was associated with decreased survival compared to chemoradiation and SBRT.

Keywords: Non-small cell lung cancer; Radiotherapy; Surgery; Survival; Treatment patterns.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Chemoradiotherapy*
  • Databases, Factual
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pneumonectomy*
  • Radiosurgery*
  • Retrospective Studies
  • Survival Analysis
  • United States
  • Young Adult