Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival.
Ann Surg
; 273(5): 850-857, 2021 05 01.
Article
in English
| MEDLINE | ID: covidwho-1171640
ABSTRACT
OBJECTIVE:
The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. SUMMARY OF BACKGROUND DATA During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3âmonths for early NSCLC.METHODS:
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 90-120âdays 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.RESULTS:
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).CONCLUSIONS:
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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Carcinoma, Non-Small-Cell Lung
/
Time-to-Treatment
/
Lung Neoplasms
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Humans
Language:
English
Journal:
Ann Surg
Year:
2021
Document Type:
Article
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