Should Patients Wait to Undergo Surgery for Early-Stage Lung Cancer?

Patients with early-stage non-small cell lung cancer (NSCLC) should not delay undergoing surgery, as waiting too long may increase the risk of recurrence and lead to poorer overall survival (OS), a study found.

Reporting in JAMA Network Open, the researchers concluded, “Efforts to minimize delays in surgical procedures for lung cancer are essential to decrease the risk of disease recurrence and the associated worse prognosis.”

They retrospectively reviewed data from the Veterans Health Administration system on patients with clinical stage I NSCLC who were undergoing resection from 2006 through 2016. They analyzed how time to surgical treatment (TTS)—defined as the time from preoperative radiographic imaging to surgery—was correlated with delayed-associated outcomes, including pathologic upstaging, resection with positive margins, and recurrence, as well as OS.

Waiting for Surgery Decreases Survival, Increases Recurrence Risk

There were 9,904 patients identified from the VHA, most of whom were men (n=9,539) and current smokers (n=4,972). The mean age was 67.7 years, and the mean TTS was 70.1 days. One of the factors associated with a higher likelihood of recurrence was longer TTS; the risk increased after 12 weeks, according to the authors, with every week of delay past the 12-week mark increasing the hazard for recurrence by 0.4%. OS was much better among patients who were treated within 12 weeks of diagnosis compared to those who waited more than 12 weeks (hazard ratio, 1.132; 95% confidence interval [CI], 1.064-1.204; P<0.001).

Who’s More Likely to Wait for Surgery?

The following factors were predictive of delayed surgery: African American race (odds ratio [OR] vs. white race, 1.267; 95% CI, 1.112-1.444; P<0.001), higher area deprivation index (ADI) score (OR for every 1-unit increase in ADI score, 1.005; 95% CI, 1.002-1.007; P=0.002), lower hospital case load (OR for every 1-unit increase in case load, 0.998; 95% CI, 0.998-0.999; P=0.001), and less recent procedure (OR for each additional year, 0.900; 95% CI, 0.884-0.915; P<0.001).

‘Promptly Seek Treatment’ to Increase Survival

The odds of survival are highest among early-stage patients—like those evaluated in the study—and therefore those patients should be treated as soon as possible, according to senior study author Varun Puri, MD.

“That’s why it’s critical for patients to promptly seek treatment within 12 weeks after they’ve been diagnosed,” said Dr. Puri, a thoracic surgeon and professor of surgery, in a press release.

“Our data provide particularly timely information regarding delayed medical care, a common issue during the ongoing global pandemic,” Dr. Puri added. “Physicians and patients want to know more about the safety of delaying surgery. The risks have been poorly understood because previous studies have used imprecise definitions for the date of cancer diagnosis. The goal of our study was to provide more uniform data, which we did by tracking patients from most recent CT scan diagnosis to day of surgery.”