This study aimed to assess whether surgery is beneficial for patients with advanced stage 4 NSCLC that has spread to other parts of the body. The authors concluded that for these patients, surgery resulted in longer survival time compared to those who did not undergo surgery.

For many patients with non-small cell lung cancer (NSCLC), the cancer spreads through the body (metastases, or stage 4). Once the cancer has spread, treatment options are limited. Surgery is usually the first option for early stage lung cancer, but it is not clear whether surgery would be beneficial for patients with advanced lung cancer that has spread. This study therefore looked at whether patients with stage IV metastatic non-small-cell lung cancer (NSCLC) would benefit from surgical intervention.

This study examined whether patients with stage 4 NSCLC benefit from surgical intervention. Information on 43,538 patients was selected from a US cancer registry database. Of these patients, 89% had no surgical intervention, 6.7% had metastatic tumor resection (MTR;  surgery on the tumors that had spread), 3.5% had primary tumor resection (PTR; surgery on the initial tumor) and 0.8% had both MTR and PTR.

Average overall survival (OS; time from treatment until death from any cause) for patients without surgery was 11.1 months. For patients who underwent MTR, OS was 14.7 months for those who underwent MTR and was 29.4 months for those who underwent PTR. Average OS was 34.9 months for those patients who had both types of surgery.

Compared to patients who did not have surgery, MTR improved the chances of survival by 17%. For patients who underwent PTR compared to those who did not have surgery, there was a 48% better chance. Finally, patients who underwent both types of surgery had a 66% better chance of survival.

The authors concluded that in patients with stage 4 NSCLC surgical intervention was associated with improved survival times. 

This study does not identify whether surgery works better depending on the areas of metastases (e.g. liver, bone etc.).