Distinguishing Optimal Candidates for Primary Tumor Resection in Patients with Metastatic Lung Adenocarcinoma: A Predictive Model Based on Propensity Score Matching

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 May 1

PMID 38690000

Authors

Yuying Qi

Xiaojin Guo

Zijie Li

Bingzhang Ren

Zhiyu Wang

Affiliations

Soon will be listed here.

Abstract

Background: Primary tumor resection is associated with survival benefits in patients with metastatic lung adenocarcinoma (mLUAD). However, there are no established methods to determine which individuals would benefit from surgery. Therefore, we developed a model to predict the patients who are likely to benefit from surgery in terms of survival.

Methods: Data on patients with mLUAD were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Depending on whether surgery was performed on the primary tumor, patients were categorized into two groups: cancer-directed surgery (CDS) and no-cancer-directed surgery (No-CDS). Propensity Score Matching (PSM) was utilized to address bias between the CDS and No-CDS groups. The prognostic impact of CDS was assessed using Kaplan-Meier analysis and Cox proportional hazard models. Subsequently, we constructed a nomogram to predict the potential for surgical benefits based on multivariable logistic regression analysis using preoperative factors.

Results: A total of 89,039 eligible patients were identified, including 6.4% (5705) who underwent surgery. Following PSM, the CDS group demonstrated a significantly longer median overall survival (mOS) compared with the No-CDS group (23 [21-25] vs. 7 [7-8] months; < 0.001). The nomogram showed robust performance in both the training and validation sets (area under the curve [AUC]: 0.698 and 0.717, respectively), and the calibration curves exhibited high consistency. The nomogram proved clinically valuable according to decision curve analysis (DCA). According to this nomogram, surgical patients were categorized into two groups: no-benefit candidates and benefit candidates groups. Compared with the no-benefit candidate group, the benefit candidate group was associated with longer survival (mOS: 25 vs. 6 months, < 0.001). Furthermore, no difference in survival was observed between the no-benefit candidates and the no-surgery groups (mOS: 6 vs. 7 months, = 0.9).

Conclusions: A practical nomogram was developed to identify optimal CDS candidates among patients with mLUAD.

References

Tas F, Ciftci R, Kilic L, Karabulut S . Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett. 2013; 6(5):1507-1513. PMC: 3813578. DOI: 10.3892/ol.2013.1566. View

Balachandran V, Gonen M, Smith J, DeMatteo R . Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015; 16(4):e173-80. PMC: 4465353. DOI: 10.1016/S1470-2045(14)71116-7. View

Yang F, Xie H, Wang Y . Prognostic Nomogram and a Risk Classification System for Predicting Overall Survival of Elderly Patients with Fibrosarcoma: A Population-Based Study. J Oncol. 2021; 2021:9984217. PMC: 8476268. DOI: 10.1155/2021/9984217. View

David E, Canter R, Chen Y, Cooke D, Cress R . Surgical Management of Advanced Non-Small Cell Lung Cancer Is Decreasing But Is Associated With Improved Survival. Ann Thorac Surg. 2016; 102(4):1101-9. PMC: 5497727. DOI: 10.1016/j.athoracsur.2016.04.058. View

Sun Z, Sui X, Yang F, Wang J . Effects of primary tumor resection on the survival of patients with stage IV extrathoracic metastatic non-small cell lung cancer: A population-based study. Lung Cancer. 2018; 129:98-106. DOI: 10.1016/j.lungcan.2018.11.012. View

Li D, Zhu X, Wang H, Qiu M, Li N . Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis. J Thorac Dis. 2017; 9(2):310-317. PMC: 5334109. DOI: 10.21037/jtd.2017.02.21. View

GARLAND L, BEIER R, Coulson W, HEALD J, Stein R . The apparent sites of origin of carcinomas of the lung. Radiology. 1962; 78:1-11. DOI: 10.1148/78.1.1. View

David E, Andersen S, Beckett L, Melnikow J, Kelly K, Cooke D . A Model to Predict the Use of Surgical Resection for Advanced-Stage Non-Small Cell Lung Cancer Patients. Ann Thorac Surg. 2017; 104(5):1665-1672. PMC: 7491367. DOI: 10.1016/j.athoracsur.2017.05.071. View

Ahmed S, Shahid R, Leis A, Haider K, Kanthan S, Reeder B . Should noncurative resection of the primary tumour be performed in patients with stage iv colorectal cancer? A systematic review and meta-analysis. Curr Oncol. 2013; 20(5):e420-41. PMC: 3805411. DOI: 10.3747/co.20.1469. View

10.

Ahmed S, Leis A, Fields A, Chandra-Kanthan S, Haider K, Alvi R . Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: results from a large population-based cohort study. Cancer. 2013; 120(5):683-91. DOI: 10.1002/cncr.28464. View

11.

He J, Li Y, An J, Hu L, Zhang J . Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis. World J Surg Oncol. 2017; 15(1):36. PMC: 5288889. DOI: 10.1186/s12957-017-1105-8. View

12.

Yavuz H, Tekneci A, Ozdil A, Cagirici U . Bibliometric analysis of 40 most cited articles comparing video-assisted thoracic surgery and robotic-assisted thoracic surgery in lung cancer (1997-2021). Heliyon. 2023; 9(10):e20765. PMC: 10582371. DOI: 10.1016/j.heliyon.2023.e20765. View

13.

Musri F, Mutlu H, Karaagac M, Karakurt Eryilmaz M, Gunduz S, Artac M . Primary Tumor Resection and Survival in Patients with Stage IV Gastric Cancer. J Gastric Cancer. 2016; 16(2):78-84. PMC: 4944006. DOI: 10.5230/jgc.2016.16.2.78. View

14.

Pillay B, Wootten A, Crowe H, Corcoran N, Tran B, Bowden P . The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2015; 42:56-72. DOI: 10.1016/j.ctrv.2015.11.007. View

15.

Zhu S, Ge T, Hu J, Jiang G, Zhang P . Prognostic value of surgical intervention in advanced lung adenocarcinoma: a population-based study. J Thorac Dis. 2021; 13(10):5942-5953. PMC: 8575796. DOI: 10.21037/jtd-21-997. View

16.

Thompson A, Turner R, Hayen A, Aniss A, Jalaty S, Learoyd D . A preoperative nomogram for the prediction of ipsilateral central compartment lymph node metastases in papillary thyroid cancer. Thyroid. 2013; 24(4):675-82. PMC: 3993080. DOI: 10.1089/thy.2013.0224. View

17.

Kozower B, Larner J, Detterbeck F, Jones D . Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl):e369S-e399S. DOI: 10.1378/chest.12-2362. View

18.

Wu Y, Zhu P, Chen Y, Chen J, Xu L, Zhang H . Relationship between marital status and survival in patients with lung adenocarcinoma: A SEER-based study. Medicine (Baltimore). 2022; 101(1):e28492. PMC: 8735761. DOI: 10.1097/MD.0000000000028492. View

19.

Song W, Miao D, Chen L . Nomogram for predicting survival in patients with pancreatic cancer. Onco Targets Ther. 2018; 11:539-545. PMC: 5790064. DOI: 10.2147/OTT.S154599. View

20.

Ayanian J, Kohler B, Abe T, Epstein A . The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993; 329(5):326-31. DOI: 10.1056/NEJM199307293290507. View