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. 2017 Apr;103(4):1070-1075.
doi: 10.1016/j.athoracsur.2016.09.053. Epub 2017 Jan 19.

Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

Pamela Samson  1 , Traves D Crabtree  1 , Cliff G Robinson  2 , Daniel Morgensztern  3 , Stephen Broderick  4 , A Sasha Krupnick  1 , Daniel Kreisel  1 , G Alexander Patterson  1 , Bryan Meyers  1 , Varun Puri  5
Affiliations

Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

Pamela Samson et al. Ann Thorac Surg. 2017 Apr.

Abstract

Background: Induction therapy leads to significant improvement in survival for selected patients with stage IIIA non-small cell lung cancer. The ideal time interval between induction therapy and surgery remains unknown.

Methods: Clinical stage IIIA non-small cell lung cancer patients receiving induction therapy and surgery were identified in the National Cancer Database. Delayed surgery was defined as greater than or equal to 3 months after starting induction therapy. A logistic regression model identified variables associated with delayed surgery. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to evaluate variables independently associated with overall survival.

Results: From 2006 to 2010, 1,529 of 2,380 (64.2%) received delayed surgery. Delayed surgery patients were older (61.2 ± 10.0 years versus 60.3 ± 9.2; p = 0.03), more likely to be non-white (12.4% versus 9.7%; p = 0.046), and less likely to have private insurance (50% versus 58.2%; p = 0.002). Delayed surgery patients were also more likely to have a sublobar resection (6.3% versus 2.9%). On multivariate analysis, age greater than 68 years (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.1 to 1.7) was associated with delayed surgery, whereas white race (OR, 0.75; 95% CI, 0.57 to 0.99) and private insurance status (OR, 0.82; 95% CI, 0.68 to 0.99) were associated with early surgery. Delayed surgery was associated with higher risk of long-term mortality (hazard ratio, 1.25; 95% CI, 1.07 to 1.47).

Conclusions: Delayed surgery after induction therapy for stage IIIA lung cancer is associated with shorter survival, and is influenced by both social and physiologic factors. Prospective work is needed to further characterize the relationship between patient comorbidities and functional status with receipt of timely surgery.

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Figures

Figure 1
Figure 1
Histogram of clinical Stage IIIA NSCLC patients in the NCDB from 2006–2012, by length of time between start of induction therapy and date of surgical resection.
Figure 1
Figure 1
Histogram of clinical Stage IIIA NSCLC patients in the NCDB from 2006–2012, by length of time between start of induction therapy and date of surgical resection.
Figure 2
Figure 2
Kaplan-Meier analysis for clinical Stage IIIA NSCLC patients, by early versus delayed interval from the start of induction therapy to date of surgery.
Figure 2
Figure 2
Kaplan-Meier analysis for clinical Stage IIIA NSCLC patients, by early versus delayed interval from the start of induction therapy to date of surgery.
Figure 3
Figure 3
Kaplan-Meier analysis for clinical Stage IIIA NSCLC patients with positive surgical margins (≥R1), by early versus delayed interval from the start of induction therapy to date of surgery.
See this image and copyright information in PMC

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