Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer

• DOI: 10.1001/jamanetworkopen.2021.11613
• Publication Date: 2021-05-28T01:57:26Z
• Authors: Brendan T. Heiden; Daniel B. Eaton; Kathryn E. Engelh...; Su-Hsin Chang; Yan Yan; Mayank R. Patel; Daniel Kreisel; Ruben G. Nava; Bryan F. Meyers; Benjamin D. Kozower; Varun Puri
• Keywords: Interquartile range; Surgical oncology

<h3>Importance</h3> The association between delayed surgical treatment and oncologic outcomes in patients with non–small cell lung cancer (NSCLC) is poorly understood given that prior studies have used imprecise definitions for the date of diagnosis. <h3>Objective</h3> To use a uniform method to quantify delay examine its several outcomes. <h3>Design, Setting, Participants</h3> This retrospective cohort study was conducted using novel data set from Veterans Health Administration (VHA) system. Included had clinical stage I NSCLC were undergoing resection 2006 2016 within VHA Time (TTS) defined as time preoperative diagnostic computed tomography imaging treatment. We evaluated TTS delay-associated restricted cubic spline functions. Data analyses performed November 2021. <h3>Exposure</h3> Wait diagnosis (ie, TTS). <h3>Main Outcomes Measures</h3> Several outcomes, including pathologic upstaging, positive margins, recurrence, assessed. also assessed overall survival. <h3>Results</h3> Among 9904 who underwent NSCLC, 9539 (96.3%) men, 4972 individuals (50.5%) currently smoking, mean (SD) age 67.7 (7.9) years. 70.1 (38.6) days. not associated increased risk upstaging or margins. Recurrence detected 4158 (42.0%) median (interquartile range) follow-up 6.15 (2.51-11.51) Factors recurrence included younger (hazard ratio [HR] every 1-year increase age, 0.992; 95% CI, 0.987-0.997;<i>P</i> = .003), higher Charlson Comorbidity Index score (HR 1-unit composite score, 1.055; 1.037-1.073;<i>P</i> &lt; .001), segmentectomy vs lobectomy, 1.352; 1.179-1.551;<i>P</i> .001) wedge 1.282; 1.179-1.394;<i>P</i> larger tumor size (eg, 31-40 mm &lt;10 mm; HR, 1.209; 1.051-1.390;<i>P</i> .008), grade II I; 1.210; 1.085-1.349;<i>P</i> lower number lymph nodes examined ≥10 &lt;10; 0.866; 0.803-0.933;<i>P</i> (III 1.571; 1.351-1.837;<i>P</i> longer TTS, increasing after 12 weeks. For each week beyond weeks, hazard by 0.4% (HR, 1.004; 1.001-1.006;<i>P</i> .002). African American race (odds [OR] White race, 1.267; 1.112-1.444;<i>P</i> area deprivation index [ADI] (OR 1 unit ADI 1.005; 1.002-1.007;<i>P</i> .002), hospital case load load, 0.998; 0.998-0.999;<i>P</i> year diagnosis, less recent procedures more likely additional year, 0.900; 0.884-0.915;<i>P</i> .001). Patients weeks significantly better survival than those 1.132; 1.064-1.204;<i>P</i> <h3>Conclusions Relevance</h3> Using precise definition this found worse These findings suggest should undergo expeditious frame.