Chest
Volume 152, Issue 6, December 2017, Pages 1239-1250
Journal home page for Chest

Original Research: Lung Cancer
Impact of Timing of Lobectomy on Survival for Clinical Stage IA Lung Squamous Cell Carcinoma

https://doi.org/10.1016/j.chest.2017.07.032Get rights and content

Background

Because the relationship between the timing of surgery following diagnosis of lung cancer and survival has not been precisely described, guidelines on what constitutes a clinically meaningful delay of resection of early-stage lung cancer do not exist. This study tested the hypothesis that increasing the time between diagnosis and lobectomy for stage IA squamous cell carcinoma (SCC) would be associated with worse survival.

Methods

The association between timing of lobectomy and survival for patients with clinical stage IA SCC in the National Cancer Data Base (2006-2011) was assessed using multivariable Cox proportional hazards analysis and restricted cubic spline (RCS) functions.

Results

The 5-year overall survival of 4,984 patients who met study inclusion criteria was 58.3% (95% CI, 56.3-60.2). Surgery was performed within 30 days of diagnosis in 1,811 (36%) patients, whereas the median time to surgery was 38 days (interquartile range, 23, 58). In multivariable analysis, patients who had surgery 38 days or more after diagnosis had significantly worse 5-year survival than patients who had surgery earlier (hazard ratio, 1.13 [95% CI, 1.02-1.25]; P = .022). Multivariable RCS analysis demonstrated the hazard ratio associated with time to surgery increased steadily the longer resection was delayed; the threshold time associated with statistically significant worse survival was ∼90 days or greater.

Conclusions

Longer intervals between diagnosis of early-stage lung SCC and surgery are associated with worse survival. Although factors other than the timing of treatment may contribute to this finding, these results suggest that efforts to minimize delays beyond those needed to perform a complete preoperative evaluation may improve survival.

Section snippets

NCDB

Data from the NCDB, which is a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, was used in this study. The NCDB contains data from more than 30 million patients and 1,500 cancer centers in the United States and contains more than 70% of all newly diagnosed cases of cancer in the United States annually.12 All clinical staging information was directly recorded in the NCDB using American Joint Committee on Cancer, sixth13 and seventh editions’

Results

The study cohort consisted of 4,984 patients who underwent lobectomy for clinical stage IA (cT1, N0, M0) lung SCC at least 1 day after diagnosis of lung cancer (Fig 1). Median time to surgery was 38 days (interquartile range [IQR], 24, 60) and 95% of patients underwent surgery within 4 months of diagnosis. Table 1 details the preoperative baseline characteristics and perioperative outcomes stratified by whether surgery was performed before or after the median delay of 38 days. Table 2 shows the

Discussion

This study examined the relationship between timing of lobectomy following diagnosis of lung SCC and overall survival for clinical stage IA patients. Our study found that the median delay between diagnosis and surgery in the NCDB was 38 days. Patients whose surgery was 38 or more days after diagnosis were found to have worse survival in both univariable and multivariable analysis. When we characterized the nonlinear relationship between timing of lobectomy and survival using restricted cubic

Acknowledgments

Author contributions: C. J. Y. is the guarantor of the paper and takes responsibility for the integrity of the work as a whole. C. J. Y., H. W., and A. K. contributed equally in literature search, figures, study design, data collection, data analysis, interpretation and writing, and revisions. X. W. contributed to analyzing and interpreting the data as well as revisions. T. A. D., M. G. H., and M. F. B. contributed to design, data analysis, and interpretation and revisions.

References (45)

  • W.D. Travis et al.

    The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 classification

    J Thoracic Oncol

    (2015)
  • E. Radzikowska et al.

    Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population-based study of 20 561 cases

    Ann Oncol

    (2002)
  • N. Mohammed et al.

    Rapid disease progression with delay in treatment of non-small-cell lung cancer

    Inte J Radiat Oncol Biol Phys

    (2011)
  • S. Everitt et al.

    The impact of time between staging PET/CT and definitive chemo-radiation on target volumes and survival in patients with non-small cell lung cancer

    Radiother Oncol

    (2013)
  • K. Kashiwabara et al.

    Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor

    Lung Cancer

    (2003)
  • H. Bozcuk et al.

    Does treatment delay affect survival in non-small cell lung cancer? A retrospective analysis from a single UK centre

    Lung Cancer

    (2001)
  • K. Kashiwabara et al.

    Outcome in patients with lung cancer found retrospectively to have had evidence of disease on past lung cancer mass screening roentgenograms

    Lung Cancer

    (2002)
  • S. Pita-Fernandez et al.

    Relationship between delayed diagnosis and the degree of invasion and survival in lung cancer

    J Clin Epidemiol

    (2003)
  • E.R. Salomaa et al.

    Delays in the diagnosis and treatment of lung cancer

    Chest

    (2005)
  • P. Nadpara et al.

    Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: A population-based study

    Cancer Epidemiol

    (2015)
  • SEER. Cancer Statistics Factsheets: Lung and Bronchus Cancer. National Cancer Institute. Bethesda,...
  • R.L. Quarterman et al.

    Effect of preoperative delay on prognosis for patients with early stage non-small cell lung cancer

    J Thoracic Cardiovasc Surg

    (2003)
  • Cited by (64)

    View all citing articles on Scopus

    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

    View full text