• J. Thorac. Cardiovasc. Surg. · Dec 2024

    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, and Jeffrey B Velotta.
    • Division of General Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA. Electronic address: htupper@mednet.ucla.edu.
    • J. Thorac. Cardiovasc. Surg. 2024 Dec 12.

    ObjectiveMost 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.MethodsWe 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.ResultsAmong 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)).ConclusionsAlthough 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.Copyright © 2024. Published by Elsevier Inc.

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