2019 STS: Stage Correlation, Guideline-Concordant Care, and Survival in NSCLC
Posted: Thursday, February 7, 2019
There seems to be a strong correlation between clinical and pathologic stage in patients with non–small cell lung cancer (NSCLC), according to research presented at the 2019 Society of Thoracic Surgeons (STS) Annual Meeting in San Diego. However, most patients with stage IIA to IIIA NSCLC do not receive therapy consistent with guidelines, and this lack of guideline-concordant therapy may be associated with inferior survival outcomes.
“Given that current diagnostic modalities for clinical staging are reasonable, identifying patient or provider factors [that] contribute to these differences is crucial to improve the overall quality of patient care and long-term outcomes,” concluded S. M. Stokes, MD, of the University of Utah, Salt Lake City, and colleagues.
In a retrospective study of 96,968 patients with NSCLC in the National Cancer Database who had undergone surgical resection between 2004 and 2014, a strong correlation between clinical and pathologic stage was identified (r = .70). Stage-specific accuracy varied, ranging from 56.6% to 73.9%, although primary tumor staging uniformity was high (71.2%–84.5%). Overall, the positive predictive staging value was 78.1%. Downstaging of primary T2 tumors (22.9%–84.5%) as well as positive nodes (17.8%) were associated with neoadjuvant therapy. Of note ,T1 tumors were infrequently downstaged (1.6%).
The highest rate of guideline-appropriate treatments was observed in patients with stage IA and stage IB disease, at 97.0% and 98.3%, respectively. Patients with stage IIA to IIIA disease received guideline-concordant treatment at a decreased rate (47.9%, 47.3%, and 32.1%). An association was identified between receipt of guideline-appropriate care and a meaningfully lower risk of death (hazard ratio = 0.84). This association was noted with all disease stages except stage IIIA (hazard ratio = 1.07), caused by a faction of patients with stage IIIA NSCLC who did not respond to neoadjuvant treatment (hazard ratio = 1.22).
Disclosure: The study authors’ disclosure information may be found at sts.org.