Minimizing NSCLC surgical delays considered ‘essential’
medwireNews: Disease recurrence is more likely and overall survival worse for patients with stage I non-small-cell lung cancer (NSCLC) who do not receive surgery within 12 weeks of radiographic diagnosis, research suggests.
Brendan Heiden (Washington University School of Medicine, St Louis, Missouri, USA) and co-authors say that “[e]fforts to minimize delays in surgical procedures for lung cancer are essential to decrease the risk of disease recurrence and the associated worse prognosis.”
The cohort study included 9904 patients (96% men, mean age 68 years) cared for within the US Veterans Health Administration system who had clinical stage I NSCLC resected between 2006 and 2016. Most (70.1%) of the patients underwent a lobectomy and over half (53.3%) had a minimally invasive incision.
Overall, 12% of patients had pathologic upstaging at time of surgery and 3% had a positive surgical margin. By day 30, 2.1% of patients had died and 8.2% had been readmitted to hospital.
During a median follow-up of 6.15 years, 42% of the patients had recurrent disease, with a median time to recurrence of 1.24 years.
The researchers primarily looked at the time between radiographic diagnosis and surgical treatment, which they explain is “a more robust and precise method for quantifying surgical delay,” compared with the “inherently imprecise and subjective nature” of the alternative method that uses the date from initial cancer diagnosis.
The mean wait time between radiographic diagnosis and surgical treatment was 70.1 days and the researchers found that, among other factors, patients who had surgery more than 12 weeks after receiving a radiographic diagnosis were significantly more likely to have recurrent disease than those who had surgery within 12 weeks.
The risk for recurrence increased by 0.4% for each additional week after week 12, the researchers report in JAMA Network Open. “These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time frame,” say Heiden et al.
The findings also showed that patients who had surgery after 12 weeks were a significant 13% more likely to die than those treated earlier.
However, time between radiographic diagnosis and surgery was not significantly associated with pathologic upstaging or positive surgical margins, which may “suggest that while patients with clinical stage I lung cancer should continue to undergo expedient resection, there may be only a modest biologic penalty associated with short-term delays (ie, those less than 3 months) if additional workup or optimization are required,” the team notes.
The mean time from initial cancer diagnosis, coded in the Veterans Affairs’ Corporate Data Warehouse, to surgery was 48.5 days, but surgical delays beyond 12 weeks based on this measure were not significantly associated with an increased risk for recurrence.
In multivariable analyses, factors found to increase a patient’s likelihood of having surgery delayed beyond 12 weeks included being African American, having a high area deprivation index score, attending a hospital with a low case load, more distant year of diagnosis, and undergoing a preoperative mediastinoscopy or endobronchial ultrasonography.
The researchers stress that endeavors to minimize surgical delays are “particularly important in the face of compromised access to care during the ongoing COVID-19 pandemic, but also instrumental in ensuring timely care at a programmatic level for a disease that is the leading cause of cancer-related mortality in the US.”
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