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. 2023 Mar 31;15(3):1106-1114.
doi: 10.21037/jtd-22-1091. Epub 2023 Mar 13.

Narrowing the therapeutic window?-A case-control study on the influence of the COVID-19 pandemic on the primary UICC stage of NSCLC

Isabella B Metelmann  1 , Sebastian Kraemer  1 , Matthias Steinert  1 , Stephan Kersting  2 , Alexandra Busemann  2
Affiliations

Narrowing the therapeutic window?-A case-control study on the influence of the COVID-19 pandemic on the primary UICC stage of NSCLC

Isabella B Metelmann et al. J Thorac Dis. .

Abstract

Background: General clinical perception suggests a decline in the diagnosis and treatment of lung cancer during the SARS-CoV-2 pandemic. Early diagnosis of non-small cell lung cancer (NSCLC) is crucial in therapeutic regimes as early stages are potentially curable by operation alone or with combined therapy. Pandemic-triggered overload of the healthcare system may have prolonged the diagnosis of NSCLC, possibly leading to higher tumor stages at first diagnosis. This study aims to identify how COVID-19 affected the distribution of the Union for International Cancer Control (UICC) stage in NSCLC at first diagnosis.

Methods: A retrospective case-control study was conducted, including all patients receiving their first diagnosis of NSCLC in the regions of Leipzig and Mecklenburg-Vorpommern (MV) between January 2019 and March 2021. Patient data were retrieved from the clinical cancer registries of the city of Leipzig and the federal state of MV. Ethical approval for this retrospective evaluation of archived, anonymized patient data was waived by the Scientific Ethical Committee at the Medical Faculty, Leipzig University. Three investigation periods were defined to study the effects of high incidences of SARS-COV-2: the curfew period as an enacted security measure, the period of high incidence rates and the period of the aftermath of high incidences. Differences in the UICC stages between these pandemic periods were studied by Mann-Whitney-U-Test. Pearson's correlation was calculated to examine changes in operability.

Results: The number of patients diagnosed with NSCLC dropped substantially during investigation periods. There was a significant difference in the UICC status in the aftermath of high incidences and imposed security measures in Leipzig (P=0.016). N-status differed significantly in the aftermath of high incidences and imposed security measures (P=0.022) with a decrease of N0- and an increase of N3-status, respectively, while N1- and N2-status remained relatively unaffected. No pandemic phase showed a significant difference in operability.

Conclusions: The pandemic led to a delay in the diagnosis of NSCLC in the two examined regions. This resulted in higher UICC stages upon diagnosis. However, no increase in inoperable stages was shown. It remains to be seen, how this will affect the overall prognosis of the involved patients.

Keywords: COVID-19; Non-small cell lung cancer (NSCLC); SARS-CoV-2; Union for International Cancer Control stage (UICC stage); securitization.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1091/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Investigation periods in relation to incidence rates of SARS-CoV-2 in Leipzig and Mecklenburg-Vorpommern, German ICU capacity, and nationwide imposed curfews. ICU, intensive care unit.
Figure 2
Figure 2
Data enrollment according to CONSORT guidelines (12). UICC, Union for International Cancer Control; L, Leipzig; MV, Mecklenburg-Vorpommern.
Figure 3
Figure 3
Distribution of UICC stage during pandemic periods in Leipzig. *, P<0.05; **, P<0.01; †, undifferentiated concerning IVA or IVB. UICC, Union for International Cancer Control.
Figure 4
Figure 4
Distribution of N-status during pandemic periods. *, P<0.05.
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References

    1. Dolan DP, Lee DN, Polhemus E, et al. Report on lung cancer surgery during COVID-19 pandemic at a high volume US institution. J Thorac Dis 2022;14:2874-9. 10.21037/jtd-22-5 - DOI - PMC - PubMed
    1. London JW, Fazio-Eynullayeva E, Palchuk MB, et al. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clin Cancer Inform 2020;4:657-65. 10.1200/CCI.20.00068 - DOI - PMC - PubMed
    1. Morais S, Antunes L, Rodrigues J, et al. The impact of the coronavirus disease 2019 pandemic on the diagnosis and treatment of cancer in Northern Portugal. Eur J Cancer Prev 2022;31:204-14. - PMC - PubMed
    1. Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, 2020.
    1. Degeling K, Baxter NN, Emery J, et al. An inverse stage-shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID-19 pandemic. Asia Pac J Clin Oncol 2021;17:359-67. 10.1111/ajco.13505 - DOI - PMC - PubMed