Time to Treatment Impacts on Early-Stage Lung Cancer Surgery Outcomes

The leading cause of cancer-related deaths worldwide is lung cancer.¹ Most patients are diagnosed at an advanced stage.¹ The overall 5-year survival rate is 18.6%, with a 5% survival rate in patients diagnosed with advanced disease.¹ Although at this stage treatment is generally not curative, if the disease is caught while it is still localized to the lung, the 5-year survival rate is 56%.¹ Screening of high-risk patients with low-dose CT screening to find the disease at its early stages can decrease mortality rates by 14% to 20%.¹ Treatment timeliness of early-stage lung cancer has been observed to be associated with better outcomes in particular for those patients undergoing surgery, but the impact of this on survival is not well understood.²

To help foster a better understanding of time to treatment (TTT) and its impact on survival, Tang and colleagues examined the drivers of TTT for 599 patients with clinical stage I and II non–small-cell lung cancer who underwent curative lung resection between January 2014 and April 2018.² Neoadjuvant therapy was not received by the patients. The institution protocol consisted of an outpatient visit with the surgery team to evaluate suitability for surgery and a second outpatient visit immediately prior to surgery. The lung cancer evaluation protocols were mediastinal staging for central tumor or peripheral tumors >2 cm, brain MRI for patients with stage >Ib or symptoms, PET scan for all patients, and a quantitative perfusion scan for pneumonectomy patients.²

TTT was defined as the interval from date of tissue diagnosis to date of resection. If the tissue diagnosis was confirmed on the surgery date, TTT was zero (TTT = 0). There were 185 patients with TTT = 0.² These patients were more likely to have smaller tumors, a lower clinical stage, and a higher percent-predicted forced expiratory volume in 1 second (FEV1), while the 413 patients with TTT >0 had a median TTT of 42 days.² Longer TTT was found in patients with a history of smoking, stroke, chronic obstructive pulmonary disease, weight loss, and those with low and high extremes of percent-predicted FEV1, and was associated with individual surgeon factors, preoperative surgical consultation, and endoscopic bronchoscopy ultrasound.² The main drivers of longer TTT were multidisciplinary evaluation and preoperative workup. If TTT was longer than 50 days, 1- and 5-year survival rates decreased.² Predictors of worse overall survival after lung resection included longer TTT, large tumor size, older age, a higher lung cancer clinical stage, lower percent-predicted FEV1, lower diffusion lung capacity, anemia, and those patients without a preoperative cardiopulmonary stress test.²

References

1. American Lung Association. Lung cancer fact sheet. www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet. Accessed February 22, 2022.
2. Tang A, Ahmad U, Raja S, et al. How much delay matters? How time to treatment impacts overall survival in early stage lung cancer [published online ahead of print, November 18, 2021]. Ann Surg. 2021;10.1097/SLA.0000000000005307.