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

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

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Using a more precise definition for TTS, this study found that surgical procedures delayed more than 12 weeks were associated with increased risk of recurrence and worse survival. These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time f ...

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    Key Points
    • In the current retrospective study, researchers employed a uniform method to assess surgical treatment delay and its associated outcomes in 9904 patients who underwent surgical treatment for clinical stage I NSCLC at the VA.
    • Defined as time between preoperative CT and surgery, the average time-to-surgical treatment (TTS) was 70.1 days, with this measure not correlated with heightened risk of pathologic upstaging or positive margins. In 4158 patients, there was recurrence during a median follow-up period of 6.15 years. Recurrence was related to younger age, higher Charlson Comorbidity Index score, segmentectomy/wedge resection, increased tumor size, higher tumor grade, decreased number of lymph nodes examined, higher pathological stage, and longer TTS. Of note, the hazard of recurrence with each week of surgical delay after 12 weeks increased by 0.4% (HR, 1.004; 95% CI, 1.001-1.006; P = .002).
    • Factors linked to delayed treatment were Black race, higher area deprivation (ADI) score, decreased hospital case load, and year of diagnosis (i.e., patient with less recent procedures were more likely delayed). Patients who were treated surgically within 12 weeks of diagnosis exhibited longer overall survival.
    • The authors concluded, “Efforts to minimize delays in surgical procedures for lung cancer are essential to decrease the risk of disease recurrence and the associated worse prognosis. Such endeavors are particularly important in the face of compromised access to care during the ongoing COVID-19 pandemic, but also instrumental in ensuring timely care at a programmatic level for a disease that is the leading cause of cancer-related mortality in the US.”
    • The strengths of the study include its uniform cohort, with veterans having free access to health care. Additionally, information on delayed medical care was timely regardless of the COVID-19 pandemic.
    • The limitations of the current study include an “imperfect” way of quantifying TTS based on CT imaging. Additionally, the study analyzed pathologically confirmed cases of NSCLC, because definitive confirmation by pathology is usually unavailable before an operation.
    • The authors wrote, “The decision to proceed to surgical treatment as opposed to continued surveillance can be complex, especially with smaller lung nodules, which can challenge the utility of time to treatment standards in real-world practice. Our data rather suggest that for highly suspicious nodules consistent with clinic stage I disease (and certainly those with preoperative confirmatory pathology), surgical treatment within at least 12 weeks of radiographic diagnosis is prudent.”