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. 2023 Sep 18:16:948-959.
doi: 10.1016/j.xjon.2023.09.010. eCollection 2023 Dec.

Conditional survival analysis of patients with resected non-small cell lung cancer

Talib Chaudhry  1 , Vaishnavi Krishnan  1 , Andrew E Donaldson  1 , Zachary M Palmisano  1 , Sanjib Basu  1 , Nicole M Geissen  1 , Justin M Karush  1 , Gillian C Alex  1 , Jeffrey A Borgia  2   3 , Michael J Liptay  1 , Christopher W Seder  1
Affiliations

Conditional survival analysis of patients with resected non-small cell lung cancer

Talib Chaudhry et al. JTCVS Open. .

Abstract

Background: Conditional survival (CS) analyses provide an estimate of survival accounting for years already survived after treatment. We aim to evaluate the difference between actuarial and conditional survival in patients following lung resection for non-small cell lung cancer (NSCLC). In addition, CS analyses are used to examine whether prognosticators of survival change over time following surgery.

Methods: Patients who underwent anatomic lung resection at a single institution for pathologic stage I-IIIA NSCLC between 2010 and 2021 were identified; those who underwent wedge resection for node-negative tumors ≤2 cm were also included. CS estimates were calculated as the probability of remaining disease-free after x years of nonrecurrence (CSx). Kaplan-Meier, log-rank, and Cox proportional hazard methods for examining CS were used for subgroup comparisons and assessing associations with baseline covariates.

Results: Overall, 863 patients met the study inclusion criteria, with a median follow-up of 44.1 months. Conditional overall survival (OS) and disease-free survival (DFS) were greater than actuarial rates at all time points after surgery. At the time of resection, male sex (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.03 to 1.72; P = .032), tumor size >3 cm (HR, 1.17; 95% CI, 1.11-1.23; P < .001), node positivity (HR, 3.31; 95% CI, 2.52-4.33; P < .001), and American Joint Committee on Cancer stage (P < .001) were associated with DFS. However, if a patient lived 3 years without recurrence (CS3), these factors were no longer prognostic of DFS.

Conclusions: Conditional survival analyses provide dynamic assessments of OS and DFS after NSCLC resection. After 3 years without recurrence, certain characteristics associated with DFS at the time of surgery no longer prognosticate recurrence.

Keywords: conditional survival; disease-free survival; non–small cell lung cancer; prognosis.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Disease free survival and 3-year conditional disease free survival of patients with resected non-small cell lung cancer. CS3, Conditional 3-year survival.
Figure 1
Figure 1
A, Kaplan–Meier plot comparing actuarial overall survival with 3-year conditional survival. B, Kaplan–Meier plot comparing actuarial disease-free survival with 3-year conditional disease-free survival. OS, Overall survival; CS, conditional survival; DFS, disease-free survival; CDFS, Conditional disease-free survival.
Figure 2
Figure 2
Comparisons of actuarial and 3-year conditional overall survival as time after surgery progresses. CS3, Conditional 3-year survival.
Figure 3
Figure 3
Comparison of the actuarial disease-free survival of node-negative patients versus the 3-year conditional disease-free survival of node-positive patients as time after surgery progresses. DFS, Disease-free survival; CS, conditional survival.
Figure 4
Figure 4
Comparison of the actuarial disease-free survival of patients with a tumor 0 to 3 cm versus the 3-year conditional disease-free survival of patients with a tumor >3 cm as time after surgery progresses. DFS, Disease-free survival; CS, conditional survival.
Figure 5
Figure 5
Graphical abstract representing key findings of this study.
Figure E1
Figure E1
Overall survival by differing conditional survival. CS, Conditional survival.
Figure E2
Figure E2
Disease-free survival by differing conditional survival. CS, Conditional survival.
Figure E3
Figure E3
3-year conditional disease-free survival by stage. CS3, Conditional 3-year survival.
Figure E4
Figure E4
Comparison of disease-free survival (DFS) and CS3 DFS for stage I. CS3, Conditional 3-year survival.
Figure E5
Figure E5
Comparison of disease-free survival (DFS) and CS3 DFS for stage II. CS3, Conditional 3-year survival.
Figure E6
Figure E6
Comparison of disease-free survival (DFS) and CS3 DFS for stage IIIA. CS3, Conditional 3-year survival.
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