Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Mayne, Nicholas R.; Elser, Holly C.; Darling, Alice J.; Raman, Vignesh; Liou, Douglas Z.; Colson, Yolonda L.; D'Amico, Thomas A.; Yang, Chi-Fu Jeffrey
• Is Part Of: Annals of surgery. Volume 273:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: COVID-19 -- delayed treatment -- lung surgery -- non-small-cell lung cancer; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004811
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. Summary of Background Data: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. Methods: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of "early" versus "delayed" surgery (surgery received 0–30 vs 90–120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. Results: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80, 086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). Conclusions: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration. Abstract : Supplemental Digital Content is available in the text