Treatment Patterns for Patients With Unresected Stage III NSCLC: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database

Shijie Shang; Ruiyang Wang; Fei Wang; Meng Wu; Dawei Chen; Jinming Yu

doi:10.3389/fonc.2022.874022

Treatment Patterns for Patients With Unresected Stage III NSCLC: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database

Front Oncol. 2022 Jun 17:12:874022. doi: 10.3389/fonc.2022.874022. eCollection 2022.

Authors

Shijie Shang¹, Ruiyang Wang², Fei Wang², Meng Wu², Dawei Chen^{1

2}, Jinming Yu^{1

2

3}

Affiliations

¹ Department of Radiation Oncology, Shandong University Cancer Center, Jinan, China.
² Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
³ Research Unit of Radiation Oncology, Chinese Academy of Medical Sciences, Jinan, China.

Abstract

Background: Recently, immunotherapy (IO) has shown striking survival improvement in unresectable stage III non-small cell lung cancer (NSCLC). However, the role of chemo-radiotherapy (CRT) for improvement in outcomes should not be disregarded. This study aimed to compare the treatment patterns and illustrate the impact of radiotherapy on the cancer-specific survival (CSS) and overall survival (OS) of patients with unresected locally advanced stage III NSCLC.

Methods: We retrospectively analyzed the data of patients with stage III NSCLC patients who did not undergo surgery from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between 2001 and 2016, and three continuous years were regarded as one unit. Using the Kaplan-Meier method, we identified the CSS and OS. Then, a linear regression model was graphed to analyze the correlation between median survival of CSS or OS and calendar years in the radiotherapy alone, chemotherapy alone, and CRT groups.

Results: A total of 20986 patients were included in this study. In the overall cohort, CSS and OS improved consistently. To explore the reason for the improved survival, patients were divided into three different cohorts: radiotherapy alone, chemotherapy alone, and CRT. From 2001 to 2015, the median CSS improved persistently, 7, 8, 8, 9, and 11 months in the radiotherapy alone group and 12, 13, 15, 17, 19 months in the CRT group, but improvement in outcomes was less consistent in the chemotherapy alone group (10, 9, 11, 12, 12 months). To better visualize the correlation between CSS and calendar year, linear regression was performed, yielding r² = 0.8032, P = 0.0395 for the radiotherapy alone group; r² = 0.7206, P = 0.0689 for the chemotherapy alone group; and r² = 0.9878, P = 0.0006 for the CRT group. Similar findings were observed in the OS data. In addition to this, we also analyzed different pathological types and also obtained the same results.

Conclusions: The survival of patients with unresectable stage III NSCLC has improved substantially, and the most pronounced and consistent improvements were observed in the CRT group. In addition to IO, radiotherapy played an essential role in the treatment of unresectable stage III NSCLC in the past years and should be considered in the design of clinical trials.

Keywords: SEER database; non-small cell lung cancer (NSCLC); radiotherapy; stage III; unresected.