ArticleJournal of thoracic disease2026
Impact of surgical approaches on prognosis in elderly patients with T4N0M0 non-small cell lung cancer: a competing risk analysis based on the SEER database.
Article in Journal of thoracic disease, 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: The optimal surgical strategy for elderly (≥65 years) patients with T4N0M0 non-small cell lung cancer (NSCLC) remains controversial. This study compared postoperative survival outcomes among lobectomy, pneumonectomy, and sublobectomy in this population. Methods: This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) data to identify elderly patients with T4N0M0 NSCLC (2010-2021) who underwent lobectomy, pneumonectomy, or sublobectomy. The primary endpoint was cancer-specific survival (CSS), assessed using Fine-Gray competing risks models, while the secondary endpoint, overall survival (OS), was analyzed with multivariable Cox regression. Results: A total of 1,326 patients were included, of whom 963 underwent lobectomy, 117 underwent pneumonectomy, and 246 underwent sublobectomy. Multivariable Cox regression analysis demonstrated that, using lobectomy as the reference, both pneumonectomy [hazard ratio (HR) =1.46, 95% confidence interval (CI): 1.17-1.82, P<0.001] and sublobectomy (HR =1.46, 95% CI: 1.16-1.84, P=0.001) were significantly associated with a poorer OS. In the competing risks model, no significant differences in CSS were observed among the surgical groups [sublobectomy Conclusions: In elderly patients with T4N0M0 NSCLC, pneumonectomy was associated with a higher risk of all-cause mortality compared with sublobectomy, while no significant differences in CSS were observed among surgical approaches. Although sublobectomy was not associated with inferior survival, its apparent benefit may reflect selection bias and requires confirmation in prospective studies. When feasible, lobectomy may represent a more reasonable surgical option.
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