Surgery versus radiotherapy in octogenarians with stage Ⅰa non‑small cell lung cancer: Propensity score‑matching analysis of SEER database

Purpose: To compare the overall survival (OS) and cancer-specific survival (CSS) of surgery with radiotherapy in octogenarians with stage Ⅰa non–small cell lung cancer (NSCLC). Methods Patients aged ≥ 80 years with clinical stage Ⅰa (T1N0M0) NSCLC from 2012 to 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Included patients were divided into surgery and radiotherapy group. Multivariate Cox regression was used to identify factors associated with survival. Propensity score‑matching (PSM) analysis was used to adjust treatment groups. OS and CSS were compared among groups by the Kaplan–Meier analysis. Results A total of 1641 patients were identified, with 46.0% received surgery and 54.0% radiotherapy. Compared with surgery, patients treated with radiotherapy were older, later diagnosed, and had more squamous cell carcinoma, unknown grade and increased tumor size. Radiotherapy was associated with a significantly worse OS as compared with surgery (hazard ratio 2.426; 95% CI, 2.003 to 2.939; P  < .001). After PSM, the OS ( P  < 0.001) and CSS ( P  < 0.001) was higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgery and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgery and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. No differences in the OS ( P  = 0.146) and CSS ( P  = 0.675) were found between the matched surgery without lymph node examination (LNE) and radiotherapy group. Conclusions Surgery with lymph node dissection offers better OS and CSS than radiotherapy in octogenarians with stage Ⅰa NSCLC.