1. Higher Use of Surgery Confers Superior Survival in Stage I Non-Small Cell Lung Cancer.
- Author
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Mulvihill MS, Cox ML, Becerra DC, Watson JA, Voigt SL, Yerokun BA, Speicher PJ, D'Amico TA, Tong B, and Hartwig MG
- Subjects
- Academic Medical Centers, Aged, Carcinoma, Non-Small-Cell Lung pathology, Cohort Studies, Databases, Factual, Disease-Free Survival, Female, Hospitals, High-Volume, Humans, Kaplan-Meier Estimate, Lung Neoplasms pathology, Male, Middle Aged, Multivariate Analysis, Pneumonectomy methods, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, United States, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung surgery, Hospital Mortality, Lung Neoplasms mortality, Lung Neoplasms surgery, Pneumonectomy mortality
- Abstract
Background: Lobar resection is the gold standard therapy for medically fit patients with stage I non-small cell lung cancer (NSCLC). However, considerable variability exists in the use of surgical therapy. This study tested the hypothesis that center-based variation in the use of surgical therapy affects survival in NSCLC., Methods: We queried the National Cancer Database for patients with stage I NSCLC. Mixed-effects multivariable models were developed to establish the per-center adjusted rate of surgical therapy. Patients were stratified into quartiles based on the treating center's adjusted rate of surgical therapy. Survival was estimated and then tested by using Kaplan-Meier and the log-rank test. Multivariable Cox proportional hazard models were developed to estimate the effect of rate of surgical therapy on overall survival., Results: A total of 139,802 patients met the criteria. There was wide variation in the per-center rate of surgical resection in the highest (80.8%) versus lowest (41.4%, p < 0.001) quartile. Across cohorts, patients were similar in age (mean 68.8 years in the highest quartile versus 69.7 in the lowest quartile) and Charlson-Deyo Score of 2 or greater (15.1% in the highest quartile versus 14.4% in the lowest quartile). Five-year survival was higher for patients treated at high-use centers (52.7% versus 36.7%, p < 0.001). After adjustment, an adjusted rate of surgical therapy in the lowest 25th percentile was associated with lower survival (adjusted hazard ratio 1.40, 95% confidence interval: 1.37 to 1.40, p < 0.001)., Conclusions: Treatment at a center with a higher rate of surgical therapy confers a considerable survival advantage, even after adjustment for hospital volume, surgical approach, and other confounders. Targeted efforts to improve adherence to guidelines about provision of surgical therapy in early-stage NSCLC may represent a meaningful opportunity to improve outcomes., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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