Overall survival (OS) for advanced-stage non–small cell lung cancer (NSCLC) (IIIA-IV) is highly variable, and retrospective data reveal that patients who get therapeutic intent pulmonary resection have a survival benefit. Researchers anticipated that this OS variability might be represented separately per stage, allowing for a tailored OS estimate. They used Cox proportional hazards models to assess the accuracy of the Surgical Selection Score (SSS) in predicting OS in a cohort of patients with advanced-stage NSCLC from the National Cancer Database. They determined the effect of surgery on survival by stage among people with similarly high SSS levels. 

A total of 300,572 patients were identified, with 18,701 (6%) undergoing surgery. They found SSS to be a good predictor of OS (C-index, 0.89; 95% CI, 0.89-0.90). Patients who received surgery had a considerably better overall survival rate (P<.001). Even after correcting for SSS, the risk of death was at least 2 times higher for patients in the upper quartile of SSS who did not get surgery compared to surgical patients (stage IIIA: hazard ratio [HR], 2.1; 95%) CI, 2.0-2.2, stage IIIB: HR, 2.3; 95%) CI, 2.2-2.5, stage IV: HR, 2.3; 95% CI, 2.2-2.4). The SSS is a risk assessment measure that strongly predicts individual OS. These findings are critical for a more thorough assessment of the surgical resection’s potential advantages for these individuals. The SSS can be employed during therapy decision-making for patients with advanced-stage NSCLC after more prospective validation.