Real-world guideline-based treatment of lung cancer improves short- and long-term outcomes and resection rate: A population-based study. (February 2020)

• Record Type: Journal Article
• Authors: Helminen, Olli; Valo, Johanna; Andersen, Heidi; Lautamäki, Anna; Vuohelainen, Vilma; Sihvo, Eero
• Is Part Of: Lung cancer. Volume 140(2020)
• Page Start: 1
• Page End: 7
• Publication Date: 2020-02
• Subjects: Lung cancer -- Video-assisted thoracoscopic surgery -- Guidelines -- Modern treatment -- Resection rate -- Survival; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2019.12.002
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Utility of recent lung cancer guidelines were tested in a population-based setting. Increased rate of physical evaluation, invasive staging and VATS occurred. Patients faced less complications and had shorter hospital stay. Despite higher resection rate, recurrence-free survival improved. Guideline-based therapy provides significant advances to patients with lung cancer. Abstract: Objectives: Recent guidelines for the treatment of lung cancer include comprehensive lists of recommendations for pre-operative risk evaluation, staging, and surgery. Our aim was to evaluate whether the implementation of these in a population-based real-world setting would improve outcomes. Materials and methods: All patients diagnosed with primary lung cancer in Central Finland and Ostrobothnia between January 1, 2006, and December 31, 2017, were identified from registry data ( N = 2116), including patients who underwent surgical resection ( n = 303). Data were divided into two periods, old and modern, according to which international guidelines were followed. Results: Between surgical patients of the old and modern periods, significant changes occurred in the rate of pre-operative stair climbing tests (3.7 % vs. 68.6 %, p < 0.001), the use of positron emission computed tomography (18.7 % vs. 75.7 %, p < 0.001), and invasive staging (3.7 % vs. 26.0 %, p < 0.001). In surgery, the rate of VATS (2.2 % vs. 81.1 %, p < 0.001), segmentectomy (1.5 % vs. 27.2 %, p < 0.001), and extended resections (5.2 % vs. 13.6 %, p = 0.015) increased. However, between these periods, the rate of pneumonectomy decreased from 7.5 % to 1.2 % ( p = 0.005) and bilobectomy from 9.0%–1.8% ( p = 0.004). The overall resection rate increased from 10.5%–19.7 %, mainly due to a higher number of high-risk patients (12.7 % vs. 34.3 %, p < 0.001). Patients faced fewer major complications (21.6 % vs. 8.9 %, p = 0.002) and had shorter hospital stays (9 days, IQR 7–11 vs. 5 days, IQR 3–7; p < 0.001). In the modern period, patients underwent adjuvant therapy less often than in the old period (35.1 % vs. 22.5 %, p = 0.015). Recurrence-free 5-year survival rate improved, however, from 64.0%–76.8% ( p < 0.001). Conclusions: The introduction of guideline-based modern patient evaluation and treatment was associated with improved short- and long-term outcomes of lung cancer surgery.