Time to Surgery in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Defining the Optimal Diagnosis-to-Resection Interval to Reduce Mortality

Haley I Tupper; Varada Sarovar; Kian C Banks; Julie A Schmittdiel; Diana S Hsu; Simon K Ashiku; Ashish R Patel; Lori C Sakoda; Jeffrey B Velotta

doi:10.1016/j.jtcvs.2024.11.040

Time to Surgery in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Defining the Optimal Diagnosis-to-Resection Interval to Reduce Mortality

J Thorac Cardiovasc Surg. 2024 Dec 12:S0022-5223(24)01125-5. doi: 10.1016/j.jtcvs.2024.11.040. Online ahead of print.

Authors

Haley I Tupper¹, Varada Sarovar², Kian C Banks³, Julie A Schmittdiel², Diana S Hsu³, Simon K Ashiku⁴, Ashish R Patel⁴, Lori C Sakoda⁵, Jeffrey B Velotta⁶

Affiliations

¹ Division of General Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA. Electronic address: htupper@mednet.ucla.edu.
² Division of Research, Kaiser Permanente Northern California, Oakland, CA.
³ Division of General Surgery, Department of Surgery, University of California, San Francisco East Bay, Oakland, CA.
⁴ Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA.
⁵ Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
⁶ Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA; Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.

PMID: 39674315
DOI: 10.1016/j.jtcvs.2024.11.040

Abstract

Objective: Most patient variables that impact cancer case complexity and outcomes are not modifiable pre-operatively. However, the time from diagnosis to surgical resection is fluid. This retrospective study sought to identify the optimal time from NSCLC diagnosis to surgery to reduce mortality.

Methods: We evaluated adult patients with early-stage NSCLC who underwent upfront surgical resection between 2009-2019 using institutional data. Diagnosis date was uniformly defined as the date of computed tomography (CT) that prompted diagnostic workup. We evaluated time to surgery in 2-week intervals. Using Cox regression analysis with adjustment for key patient sociodemographic, clinical and cancer characteristics, we examined time to surgery associations with recurrent/new lung cancer and overall mortality at 1 and 5-years post-surgery.

Results: Among 2567 early-stage patients, median time to surgery was 57.0 [IQR: 41.0-79.0] days. Five-year mortality was elevated for surgeries performed >8 (vs. <8) weeks (aHR [adjusted hazard ratio] 1.19 (95% CI: 1.06-1.33)) and >12 (vs. <12) weeks (aHR 1.31 (95% CI: 1.10-1.55)) post-diagnosis. One-year recurrence was also elevated for surgeries delayed >8 (vs. <8) (aHR: 1.25 (95% CI 0.98-1.60)) and >12 (vs. <12) weeks (aHR 1.62 (95% CI: 1.12-2.36)).

Conclusions: Although NSCLC aggressiveness varies, quality metrics for time to surgery are needed to optimize outcomes. This will be increasingly important as more early-stage, resectable NSCLC is identified. Our results suggest that performing surgery within 8 weeks of CT-based clinical diagnosis may be an important heath system target for early-stage NSCLC patients.

Keywords: Non-small cell lung cancer (NSCLC); cancer recurrence; early-stage; mortality; quality metric; radiologic diagnosis; time to surgery.