Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival.
Journal Article (Journal Article)
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.
Full Text
Duke Authors
Cited Authors
- Mayne, NR; Elser, HC; Darling, AJ; Raman, V; Liou, DZ; Colson, YL; D'Amico, TA; Yang, C-FJ
Published Date
- May 1, 2021
Published In
Volume / Issue
- 273 / 5
Start / End Page
- 850 - 857
PubMed ID
- 33630435
Electronic International Standard Serial Number (EISSN)
- 1528-1140
Digital Object Identifier (DOI)
- 10.1097/SLA.0000000000004811
Language
- eng
Conference Location
- United States