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David S. Ettinger, MD, FACP, FCCP


STS 2022: Does High-Intensity Surveillance After Surgery Improve Outcomes in Stage I NSCLC?

By: Vanessa A. Carter, BS
Posted: Tuesday, February 1, 2022

Brendan T. Heiden, MD, MPHS, of Washington University, St. Louis, and colleagues conducted a study to assess whether more frequent postoperative surveillance imaging following resection of stage I non–small cell lung cancer (NSCLC) correlates with improved survival. Presented during the 2022 Annual Meeting of The Society of Thoracic Surgeons (STS), these results demonstrated that high-intensity surveillance does not appear to improve survival outcomes.

“Given these concordant findings, future lung cancer treatment guidelines should consider less intense surveillance frequencies, especially in low-risk groups like patients with stage I disease,” the investigators concluded.

From a Veterans Health Administration data set, this retrospective study collected the data on 7,034 patients with pathologic stage I NSCLC who underwent surgery. Participants were divided into high-intensity (n = 3,119) and low-intensity (n = 3,913) surveillance groups, which were defined as receiving more than two CT scans or fewer than two CT scans per year, respectively.

Being a former smoker (odds ratio [OR] = 1.170), undergoing a wedge resection (OR = 1.231), and having a more recent surgical year (OR = 1.023) were factors associated with high-intensity surveillance; low-intensity surveillance appeared to correlate with Black race (OR = 0.646). The median follow-up was 7.27 years, with recurrence detected in 21.4% of patients. 

High-intensity surveillance was not associated with overall survival (hazard ratio [HR] = 0.979) nor a longer disease-free survival (HR = 0.911). Of note, these findings were sustained across multiple sensitivity analyses by tumor size, tumor grade, and number of sampled lymph nodes. Additionally, the extent of resection—lobectomy versus sublobar resection—was not observed to impact survival outcomes.

Disclosure: For disclosures of the study authors, visit

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