ArticleTranslational lung cancer research2026
Adjuvant chemotherapy for completely resected stage IB-IIA non-small cell lung cancer according to the AJCC 8th edition staging system: a real-world retrospective cohort study based on the SEER database.
Article in Translational lung cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Whether adjuvant chemotherapy confers greater survival benefit than observation alone in patients with completely resected stage IB-IIA non-small cell lung cancer (NSCLC), particularly those with high-risk features, remains unclear. This study evaluates both overall survival (OS) and lung cancer-specific survival (LCSS) to assess the efficacy of adjuvant chemotherapy in a real-world setting. Methods: We analyzed surgically resected stage IB-IIA [American Joint Committee on Cancer (AJCC) 8th edition] NSCLC patients from the Surveillance, Epidemiology, and End Results (SEER) database [2007-2021]. Multivariate Cox and Fine and Gray's competing risk regression models were applied to identify prognostic factors and to adjust for covariates in subgroup analyses. Results: Among 25,919 NSCLC patients, only 14.6% with high-risk features received adjuvant therapy. Adjuvant therapy was an independent favorable prognostic factor for OS [hazard ratio (HR) 0.89, 95% confidence interval (CI): 0.84-0.95, P<0.001], but not for LCSS [subhazard ratio (SHR) 1.04, 95% CI: 0.97-1.12, P=0.29] in the entire cohort. Subgroup analyses showed no survival benefit for stage IB patients, regardless of high-risk features status. In contrast, stage IIA patients receiving adjuvant therapy had significantly improved OS (HR 0.75, 95% CI: 0.67-0.83, P<0.001) and LCSS (SHR 0.87, 95% CI: 0.76-0.99, P=0.044). The benefit was most pronounced in stage IIA patients with high-risk features (OS: HR 0.69, 95% CI: 0.60-0.79, P<0.001; LCSS: SHR 0.76, 95% CI: 0.64-0.90, P=0.001). Conclusions: This study provides real-world evidence that adjuvant chemotherapy was associated with improved OS and LCSS outcomes in completely resected stage IIA NSCLC, particularly among those with high-risk features; however, it was not associated with improved survival in stage IB patients, regardless of their risk status.
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