| BackgroundLung cancer is one of the most common malignant tumors in the world,and it’s the first major cause of tumor-related death.NSCLC accounts for nearly 75-80% of lung cancers.While the treatment of NSCLC has been developed to the individualized treatment,the survival rate is still lower and surgery still is the key treatment in NSCLC.Tumor size is the known clinical predictors of many human cancers,and be always the primary factor that determines tumor staging and treatment.IASLC has emphasized the prognostic value of tumor size and redefined cancers larger than 7.0cm are classified as stage IV.The clinical value of NSCLC with tumors larger than 7.0cm still unknown.In order to further dividing mortality risk and evaluate prognostic factors of surgery or non-surgery in treatment of locally advanced non-small cell lung cancer.The clinical data based on SEER database were statistically analyzed to offering evidence for treatment and evaluating the prognosis.MethodsAll NSCLC cases with tumors larger than 7.0cm from 2010 to 2015,all based on Surveillance,Epidemiology and End Results database.The calculation of survival rate is by life-table method.OS was estimated by Kaplan-Meier method for comparing the differences.The COX regression models were used to assess the impact of univariate and multivariate on survival.All statistical tests were two-sided and P-value<0.05 was considered statistically significant.Results5519 patients were selected totally,and the cumulative survival rates of 1,2 and 3years were 51.8%,33.0% and 25.0% respectively.On treatment,patients with tumorslarger 7.0-8.0cm and staging N0-N1 mostly choose surgery(54.0% and 50.9%,respectively).Patients with staging N1-N2 mostly choose non-surgery(73.2% and87.7%,respectively).Patients with tumors larger 8.0-9.0cm and lymph node staging N0-N1 mostly choose surgery(45.1% and 55.7%,respectively).In the group of9.0-10.0cm and staging N0,the number of surgery and non-surgery in each group was similar,42.4% and 42.4% respectively.Patients with lymph node staging N1 choose surgery(50.4%)and non-surgery(38.6%).Most patients with N2 and N3 received non-surgical treatment(66.2% and 82.1%,respectively).Patients with tumors larger or equal to 10.0cm and staging N0-N3 mostly choose non-surgery(40.6%,42.8%,60.5%and 72.1%,respectively).The Kaplan-Meier analysis showed statistically significant differences in sex,tumor size,lymph node stage and treatment.And there were no significant differences in age,race,marriage,tumor site,tumor segmentation,and pathological type.Variable with statistical differences based on kaplan-meier analysis were incorporated into COX regression model.The bigger the tumor,the greater the risk of death.Our analysis shows that tumor size,lymph-nodes status,treatment was regarded as independent factors(P<0.001).ConclusionBased on a retrospective study of SEER database with tumors size>7.0cm in NSCLC,surgery was benefited for stage N0-N1 NSCLC patients(P<0.001).And7.0-9.0cm with N2 stage,surgical treatment had advantages in improving the prognosis of patients(P<0.001).Surgical and non-surgical patients with tumor larger or equal than9.0cm or stage N3 had no statistically significant differences in prognosis(P>0.05).In addition,palliative treatment does not benefit the prognosis of patients. |
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