Analysis of the effect of surgery on the prognosis of non-small cell lung cancer patients with single-organ extrathoracic metastases based on the SEER database

Abstract

Abstract Purpose: We used the Surveillance, Epidemiology, and End Results (SEER) database to explore the effect of primary or metastatic tumor surgery vs. no surgery on the prognosis of non-small cell lung cancer (NSCLC) patients with single-organ extrathoracic metastases. Methods: NSCLC patients with single-organ extrathoracic metastases were extracted from the SEER database. The characteristics of patients with different metastasis sites were balanced by progression-free survival, and the Kaplan‒Meier method and log-rank test were used to compare differences in cancer-specific survival (CSS). Multivariate Cox regression was performed to identify prognostic factors. Results: There were 8592, 11886, and 2814 eligible patients with brain metastases, bone metastases, and liver metastases, respectively. Multivariate Cox regression analysis showed that surgical intervention was independently associated with the CSS of patients (P < 0.001). The surgical and nonsurgical groups were subjected to propensity score matching (PSM) (1:1). After PSM, the patients who underwent surgery in the brain metastasis and bone metastasis cohorts had a better CSS (P < 0.001). Different surgical modalities for primary tumors showed greater survival benefits before and after PSM than no surgery. After PSM, the CSS of the brain metastasis cohort receiving metastatic surgery was better than that of the nonsurgical group (P < 0.001). The median CSS of patients who underwent PMTR was longer than that of patients who underwent other surgical methods (P < 0.05). Conclusion: In NSCLC patients with single-organ extrathoracic metastases, both primary tumor surgery and metastatic surgery exhibited better prognoses than no surgery.