Treatment patterns and survival outcomes in octogenarians with early-stage non-small cell lung cancer from 2011 to 2020: a SEER database analysis

Abstract Objective: This study investigated treatment patterns and survival outcomes in octogenarians with early-stage non-small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Data from the SEER 17 Registries (2000-2020) was analyzed. Patients aged 80 years or older who were diagnosed with early-stage NSCLC (stage I-IIA) between2011 and 2020 were included. Propensity score matching (PSM) was applied to balance clinical characteristics between treatment groups. Overall survival (OS) and cancer-specific survival (CSS) were assessed using Kaplan‒Meier analysis and Cox regression. Results: A total of 31371 patients aged 80 years or older were diagnosed with NSCLC in the SEER database from 2011 to 2020, including 8042 patients with early-stage I–IIA (AJCC 8th) NSCLC, 7372 of whom met the study entry criteria. Early-stage NSCLC patients increased significantly to over 30% during 2018-2020, compared to less than 25% in 2011-2017. Over the decade, radiotherapy increased from 31.2% to 49.4%, while surgery decreased from 44.5% to 32.4%. Radiotherapy has surpassed surgery and been the predominant treatment for octogenarians since 2014. A total of 5496 patients were included in survival analysis. The mediansurvival was 67 months for patients who underwent surgery and 33 months for those who received radiotherapy. Lobectomy was associated withbetter long-term OS thansegmentectomy and wedge resection. Stratification by tumor size confirmed the superiority of surgery in most categories except for the smallest tumors (0-1 cm). Conclusions: The proportion of early-stage NSCLC patients aged 80 and older increased significantly in 2018-2020 compared to 2011-2017. Radiotherapy is increasingly used to treat early-stage NSCLC in octogenarians, yet surgery provides superior long-term survival. These findings support surgical intervention as the preferred treatment for eligible octogenarians with early-stage NSCLC.