Treatment patterns and outcomes change in early-stage non-small cell lung cancer in octogenarians and older: a SEER database analysis

Background Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the world. Aims We used the Surveillance, Epidemiology, and End Results (SEER) database to investigate the changes in the incidence, treatment patterns, and outcomes of early-stage non-small cell lung cancer (NSCLC) in octogenarians and older from 1995 to 2015. Methods Using the SEER database, we identified patients >= 80 years stage I-IIa NSCLC diagnosed from 1995 to 2015. Changes in the treatment patterns, incidence and proportion, and survival were assessed by years of diagnosis. Results In total, 25,394 patients were identified. The incidence number sharply increased from 260 in 1995 to 2120 in 2015. There was a tremendous increase in the proportion who underwent radiotherapy from 22.7% in 1995 to 50% in 2015 (P < 0.0001), with a corresponding decrease in surgical treatment, from 50 to 28.6% (P < 0.0001). The 2-year cancer-specific survival (CSS) and overall survival (OS) improved for patients treated with radiation alone and relatively subtly for those who received surgery alone. Conclusion At present, RT has replaced surgery as the most commonly used modality in early-stage NSCLC in patients >= 80 years in the United States. An improvement was observed in CSS and OS for patients treated with definitive RT and surgery.