Surgery/non-surgery-based strategies for invasive locally-advanced non-small cell lung cancer in the era of precision medicine

Treatments for invasive T4 non-small cell lung cancer (NSCLC) tumors have been traditionally individualized and often require multidisciplinary team (MDT) evaluation. Advances in precision medicine may open up new opportunities for these patients. This retrospective cohort study, using the Surveillance, Epidemiology, and End Results (SEER) database, identified T4N0-3M0 NSCLC patients with central structure invasion from 2010 to 2020. Precision medicine has progressed in three periods: 2010–2014 (targeted therapy), 2015–2017 (initial immunotherapy), and 2018–2020 (latest immunotherapy). We utilized Propensity Score Matching (PSM) to control confounding factors and competing risk regression models to evaluate cancer-specific survival (CSS). A total of 9,106 cases were matched after PSM. For all populations, the median overall survival (OS) significantly increased with the advancement of precision medicine: 23.0 months in Period I (95 ​% CI: 22.0–25.0), 28.0 months in Period II (95 ​% CI: 26.0–31.0), and not reached (NR) in Period III (95 ​% CI: 30.0 – NR). Multivariate analysis also revealed a sequential survival improvement from Period I to III (p ​