Division of Thoracic Surgery, Department of Surgery
Diagnosis | Epidemiology | Health Services Administration | Health Services Research | Neoplasms | Oncology | Respiratory Tract Diseases | Surgery | Surgical Procedures, Operative
Background: Lung cancer has the highest mortality among the leading cancers in the U.S. Surgical resection is considered as the most effective treatment for lung cancer in early stages, providing greater long-term survival. Clinical guidelines on delays in resection of early-stage lung cancer do not exist. This work aims to assess whether increasing time between diagnosis/first doctor visit and surgery for early stage non-small cell lung cancer (NSCLC) is associated with poorer survival.
Methods: We identified a retrospective cohort of incident lung cancer cases who had surgical treatment for lung cancer at our institution between January 2009 and December 2017, and no prior radiation or chemotherapy. We assessed overall survival (OS) and predictors included a) time from first contact to surgery; and b) time from diagnosis to surgery. The association between time from diagnosis and time from first contact to surgery, and survival for patients with early stage NSCLC was assessed using multivariable Cox proportional hazard. We investigated four cut-off points: surgery within 15 days, 30 days, 60 days and 90 days. We controlled for sociodemographic characteristics as well as clinical outcomes.
Results: Our cohort comprised 491 patients. The age average was 66.9 years, 61% female, 94.7% white, and 9% never smoked. Clinical Stage 1A and 1B corresponded to 86.5% of patients while in pathological stage it was 76%. The 5-year overall survival was 56.0%. Surgery occurred a median 40 days after the diagnosis and 43 days after the first visit and within 35 days if the first appointment was with a thoracic surgeon. The threshold time associated with statistically significant worse survival was 60 days after diagnosis. Surgery was performed more than 60 days of diagnosis in 115 (25.7%) patients, their OS was significantly worse than patients who had surgery earlier (HR=1.7 [95% CI: 1.1-2.6]).
Conclusions: Greater intervals between diagnosis of early-stage NSCLC and surgery are associated with worse survival. Efforts to minimize delays, particularly factors that prolong the period from diagnosis to first contact with a lung cancer provider may improve survival.
non-small cell lung cancer, early stage lung cancer, surgical resection, diagnosis
Rights and Permissions
Copyright 2019 The Author(s)
DOI of Published Version
Emmerick I, Powers M, Aldrich M, Lou F, Lin P, Maxfield M, Uy K. Impact of timing of Lung resection on Survival for Clinical Stage I and II Lung Cancer. Health Services Research, Clinical Informatics, and Quality of Care. 2019 ASCO Annual Meeting; 2019 June 1; Chicago, United of States of America. J Clin Oncol 37, 2019 (suppl; abstr 6598); c2019. https://doi.org/10.1200/JCO.2019.37.15_suppl.6598
2019 American Society of Clinical Oncology (ASCO) Annual Meeting
Emmerick IC, Powers MM, Aldrich MC, Lou F, Lin P, Maxfield M, Uy KF. (2019). Impact of Timing of Lung resection on Survival for Clinical Stage I and II Lung Cancer. Surgery Publications. https://doi.org/10.1200/JCO.2019.37.15_suppl.6598. Retrieved from https://escholarship.umassmed.edu/surgery_pp/186
Diagnosis Commons, Epidemiology Commons, Health Services Administration Commons, Health Services Research Commons, Neoplasms Commons, Oncology Commons, Respiratory Tract Diseases Commons, Surgery Commons, Surgical Procedures, Operative Commons