Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival

医学 比例危险模型 腺癌 肺癌 倾向得分匹配 全国肺筛查试验 阶段(地层学) 危险系数 随机对照试验 肿瘤科 内科学 外科 生存分析 癌症 肺癌筛查 置信区间 古生物学 生物
作者
Nicholas R. Mayne,Holly Elser,Alice J. Darling,Vignesh Raman,Douglas Z. Liou,Yolonda L. Colson,Thomas A. D’Amico,Chi-Fu Jeffrey Yang
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:273 (5): 850-857 被引量:30
标识
DOI:10.1097/sla.0000000000004811
摘要

The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC.During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC.Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of "early" versus "delayed" surgery (surgery received 0-30 vs 90-120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses.In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004).The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration.
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