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. 2018 Oct;7(10):4932-4942.
doi: 10.1002/cam4.1749. Epub 2018 Sep 2.

Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers

Yanyan Lou  1 , Bhagirathbhai Dholaria  1 , Aixa Soyano  1 , David Hodge  2 , Jordan Cochuyt  2 , Rami Manochakian  1 , Stephen J Ko  3 , Mathew Thomas  4 , Margaret M Johnson  5 , Neal M Patel  5 , Robert C Miller  3 , Alex A Adjei  6 , Sikander Ailawadhi  1
Affiliations

Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers

Yanyan Lou et al. Cancer Med. 2018 Oct.

Abstract

Background: Treatment of non-small-cell lung cancer (NSCLC) has been rapidly advancing over the last decade. Academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported.

Methods: The National Cancer Database (NCDB) was used to identify NSCLC incident cases from 2004 to 2013. Overall survival (OS) was plotted by year of diagnosis and type of initial treatment center, accounting for several factors available in NCDB.

Results: A total of 1 150 722 NSCLC patients were included and separated by initial treatment center type (academic: 31.5%; nonacademic: 68.5%). Median follow-up and OS for all patients were 11.8 months (range: 0-133.6 months) and 13.1 months (95% CI: 13.08-13.17), respectively. Median OS improved significantly for those diagnosed in 2010-2013 (14.8 months [95% CI: 14.7-14.9]) as compared to 2004-2009 (12.4 months [95% CI: 12.3-12.5]) (P < 0.001). Treatment at academic centers was associated with improved OS (multivariate HR for OS = 0.929 [95% CI: 0.92-0.94], P < 0.0010). Four-year OS for academic and nonacademic cohorts was 28.5%% and 22.1%, respectively (P < 0.001), and the difference was more pronounced in stage I to III NSCLC.

Conclusion: In this largest analysis, thus far, NSCLC survival has improved over time, and type of initial treatment center significantly influences survival. Identifying and removing barriers to obtaining initial treatment of NSCLC at academic medical centers could improve OS.

Keywords: National Cancer Database; academic center; community center; non-small-cell lung cancer; outcome disparities; treatment center type.

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Figures

Figure 1
Figure 1
Kaplan‐Meier survival curve of non‐small‐cell lung cancer patients who received initial treatment at academic and community centers (log‐rank hazard ratio for overall survival—0.819, P < 0.001)
Figure 2
Figure 2
Kaplan‐Meier survival curves of stage 1‐4 non‐small‐cell lung cancer patients who received initial treatment at academic and community center (P < 0.001)
See this image and copyright information in PMC

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