A landscape of treatment options and survivorship for non-small cell lung cancer by Stage and Age. Open Access

Di, Mengyu (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/70795869n?locale=en


Objectives: To examine the utilization and the effect of surgery (SG), systemic therapy (ST) and radiation (RT) in patients with non-small-cell lung cancer (NSCLC) using a large national tumor registry database.

Methods: Patients diagnosed with NSCLC were identified using the National Cancer Data Base (NCDB). They were classified into 12 strata based on their age groups (<60, 60-75, >75) and AJCC stage (I, II, III, IV). The treatment utilization pattern was assessed in each stratum. The impact of the treatment on overall survival (OS) was explored through multivariable (MVA) Cox proportional hazards model by controlling for baseline demographics and disease characteristics.

Results: Results: A total of 1,393,073 patients were diagnosed with NSCLC from 2004 to 2015. After applying inclusion and exclusion criteria, a total of 759,155 patients were included. From the distribution of utilization in each stratum, surgery was the most frequently used treatment modality in early stage (stage I and II), including surgery only and treatments containing surgery. With stage and age increasing, the utilization rate of surgery obviously decreased. The Cox model confirmed that surgery was associated with longer survival time after adjusted for other covariates. Radiation and systemic therapy were used more for older NSCLC patients. The result of survival analysis showed that if stage of cancer and other covariates were controlled, radiation related treatments tended to have better survival with age increasing. Another finding is that systemic therapy could bring benefits to NSCLC patients except patients in stage I.

Conclusions: Surgery is still the mainstay of therapy for patients with resectable and operable early stage NSCLC. Radiation therapy offers significant long-term survival advantage in elderly patients with NSCLC. The systemic therapy can provide benefits to patients when it was combined with other treatments. Patients who are candidates to no treatment should be carefully defined.

Table of Contents

Introduction Materials and methods Data source and patient selection Definition of treatment cohorts, covariates and outcome Statistical methods  Results patient characteristics Nature distribution of treatment options by stage and age groups Variables associated with receipt of no treatment Association with overall survival Overall five-year and 10-year survival rate by stage and age group MVA survival analysis by stage and age group Discussion Conclusion

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