Surgery patterns and survival of T4N2 non-small cell lung cancer – A population-based analysis

Objectives Present study aims to explore the surgery patterns and survival of T4N2 non-small cell lung cancer (NSCLC) in real-world condition. Materials and methods Clinical stage T4N2 NSCLC patients in Surveillance, Epidemiology and End Result Program were extracted. Cox regression was used for calculation of hazard ratio (HR) and confidence interval (CI), and landmark analysis was used for survival test at different cut-off time points. Results There were 1445 eligible patients included, of which 306 patients received surgery alone, 390 patients received induction therapy, and 749 patients received adjuvant therapy. For resection types, 1210 patients received lobectomy and 235 received pneumonectomy. Among patient receiving induction therapy, the overall survival (OS) HRs of pneumonectomy at 1-year, 3-year, 5-year, and 8-year cut-off points were 1.330, 0.972, 1.231, and 1.332 (P ​= ​0.708, 0.972, 0.281 and 0.145), respectively, and cancer-specific survival (CSS) HRs at these landmark points were 2.386, 1.231, 1.455, and 1.480 (P ​= ​0.293, P ​= ​0.409, 0.059 and 0.056), respectively. Among patients receiving adjuvant therapy, the OS HRs of pneumonectomy at 1-year and 8-year cut-off points were 1.570 and 1.274 (P ​= ​0.050 and 0.087), respectively, and CSS HRs at these landmark points were 1.493 and 1.284 (P ​= ​0.096 and 0.094), respectively. Both OS and CSS of patients receiving lobectomy were superior than pneumonectomy at 3-year and 5-year in this cohort. For patients receiving surgery alone, pneumonectomy resulted in inferior survival than lobectomy at all cut-off points (all P ​< ​0.05). Conclusions Surgery after induction therapy is still an optional choice for T4N2 NSCLC, and pneumonectomy should not be excluded from treatment strategy.