Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery

Table 4

The multivariable Cox proportional hazard regression analyses for stage IVA.

Variable	Unadjusted model		Adjusted model
	HR (95% CI)	value	HR (95% CI)	value
Nonoperation	Reference		Reference
Operation	0.57 (0.49∼0.67)	<0.001	0.2 (0.06∼0.65)	0.007
Age	1.01 (1∼1.02)	0.005	1.02 (1.01∼1.03)	<0.001
Sex
Male	Reference		Reference
Female	0.78 (0.66∼0.92)	0.003	0.77 (0.61∼0.99)	0.039
Race
Caucasian	Reference		Reference
African American	1.1 (0.84∼1.46)	0.488	0.98 (0.62∼1.54)	0.915
American Indian/Alaska native	1.31 (0.54∼3.17)	0.544	2.41 (0.57∼10.15)	0.229
Asian or Pacific Islander	0.59 (0.43∼0.81)	0.001	0.62 (0.4∼0.95)	0.028
Marital status at diagnosis, n (%)
Single	Reference		Reference
Unmarried or domestic partner	0 (0∼Inf)	0.989	NA (NA∼NA)	NA
Married	1.06 (0.85∼1.33)	0.589	0.74 (0.53∼1.03)	0.076
Separated	0.94 (0.38∼2.32)	0.9	NA (NA∼NA)	NA
Divorced	1.16 (0.86∼1.56)	0.325	0.93 (0.61∼1.41)	0.729
Widowed	1.07 (0.81∼1.41)	0.646	0.71 (0.46∼1.1)	0.129
Primary site
Main bronchus	Reference		Reference
Upper lobe and lung	0.67 (0.46∼0.99)	0.043	1.11 (0.62∼2.01)	0.724
Middle lobe and lung	0.58 (0.35∼0.98)	0.043	1.1 (0.53∼2.27)	0.805
Lower lobe and lung	0.71 (0.48∼1.06)	0.097	1.16 (0.64∼2.12)	0.622
Overlapping lesion of lung	0.75 (0.31∼1.8)	0.515	1.65 (0.5∼5.48)	0.414
Grade
I: well differentiated	Reference		Reference
II: moderately differentiated	1.09 (0.71∼1.67)	0.707	1.26 (0.79∼2.01)	0.335
III: poorly differentiated	1.2 (0.79∼1.83)	0.384	1.53 (0.97∼2.41)	0.068
IV: undifferentiated anaplastic	1.29 (0.69∼2.42)	0.428	1.97 (1∼3.89)	0.05
Laterality
Right	Reference		Reference
Left	0.98 (0.83∼1.16)	0.806	0.95 (0.75∼1.21)	0.684
Bilateral involvement	0.61 (0.37∼1)	0.051	0.99 (0.41∼2.43)	0.99
Histology
Epithelial neoplasms	Reference		Reference
Squamous cell neoplasms	1.13 (0.86∼1.49)	0.371	1.09 (0.73∼1.62)	0.685
Adenomas and adenocarcinomas	0.76 (0.6∼0.96)	0.021	0.82 (0.58∼1.17)	0.281
Acinar cell neoplasms	0.47 (0.17∼1.28)	0.139	0.35 (0.11∼1.19)	0.092
Others†	1.07 (0.67∼1.71)	0.775	0.82 (0.41∼1.65)	0.583
Radiation	1.01 (0.85∼1.2)	0.923	1.1 (0.86∼1.41)	0.438
Chemotherapy	0.66 (0.56∼0.77)	<0.001	0.51 (0.4∼0.66)	<0.001
Type of surgery
Nonoperation	Reference		Reference
Local tumor destruction	0.92 (0.67∼1.27)	0.629	5.65 (1.63∼19.61)	0.006
Resection of less than one lobe	0.59 (0.49∼0.71)	<0.001	3.05 (0.93∼10)	0.065
Lobectomy	0.38 (0.28∼0.52)	<0.001	1.49 (0.45∼4.91)	0.512
Lobe or bilobectomy extended	0.25 (0.08∼0.79)	0.018	1.01 (0.2∼5.27)	0.987
Pneumonectomy	0.33 (0.11∼1.03)	0.056	NA (NA ∼ NA)	NA
Extended pneumonectomy	0.58 (0.08∼4.13)	0.586	NA (NA ∼ NA)	NA

†, histology and other types included: transitional cell papillomas and carcinomas (n = 1), mucoepidermoid neoplasms (n = 5), cystic, mucinous, and serous neoplasms (n = 72), and complex epithelial neoplasms (n = 74). local tumor destruction included laser ablation or cryosurgery, electrocautery; fulguration (included the use of hot forceps for tumor destruction). Excision or resection of less than one lobe included excision, laser excision, bronchial sleeve resection only, wedge resection, and segmental resection (including lingulectomy). The model adjusted for age, sex, race, marital status, primary site, grade, laterality, histology, AJCC stage, radiation, chemotherapy, and type of surgery.