Time to Treatment Impacts on Early-Stage Lung Cancer Surgery Outcomes

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The leading cause of cancer-related deaths worldwide is lung cancer.1 Most patients are diagnosed at an advanced stage.1 The overall 5-year survival rate is 18.6%, with a 5% survival rate in patients diagnosed with advanced disease.1 Although at this stage treatment is generally not curative, if the disease is caught while it is still localized to the lung, the 5-year survival rate is 56%.1 Screening of high-risk patients with low-dose CT screening to find the disease at its early stages can decrease mortality rates by 14% to 20%.1 Treatment timeliness of early-stage lung cancer has been observed to be associated with better outcomes in particular for those patients undergoing surgery, but the impact of this on survival is not well understood.2

To help foster a better understanding of time to treatment (TTT) and its impact on survival, Tang and colleagues examined the drivers of TTT for 599 patients with clinical stage I and II non–small-cell lung cancer who underwent curative lung resection between January 2014 and April 2018.2 Neoadjuvant therapy was not received by the patients. The institution protocol consisted of an outpatient visit with the surgery team to evaluate suitability for surgery and a second outpatient visit immediately prior to surgery. The lung cancer evaluation protocols were mediastinal staging for central tumor or peripheral tumors >2 cm, brain MRI for patients with stage >Ib or symptoms, PET scan for all patients, and a quantitative perfusion scan for pneumonectomy patients.2

TTT was defined as the interval from date of tissue diagnosis to date of resection. If the tissue diagnosis was confirmed on the surgery date, TTT was zero (TTT = 0). There were 185 patients with TTT = 0.2 These patients were more likely to have smaller tumors, a lower clinical stage, and a higher percent-predicted forced expiratory volume in 1 second (FEV1), while the 413 patients with TTT >0 had a median TTT of 42 days.2 Longer TTT was found in patients with a history of smoking, stroke, chronic obstructive pulmonary disease, weight loss, and those with low and high extremes of percent-predicted FEV1, and was associated with individual surgeon factors, preoperative surgical consultation, and endoscopic bronchoscopy ultrasound.2 The main drivers of longer TTT were multidisciplinary evaluation and preoperative workup. If TTT was longer than 50 days, 1- and 5-year survival rates decreased.2 Predictors of worse overall survival after lung resection included longer TTT, large tumor size, older age, a higher lung cancer clinical stage, lower percent-predicted FEV1, lower diffusion lung capacity, anemia, and those patients without a preoperative cardiopulmonary stress test.2

References

  1. American Lung Association. Lung cancer fact sheet. www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet. Accessed February 22, 2022.
  2. Tang A, Ahmad U, Raja S, et al. How much delay matters? How time to treatment impacts overall survival in early stage lung cancer [published online ahead of print, November 18, 2021]. Ann Surg. 2021;10.1097/SLA.0000000000005307.

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