AATS 2018: Staging-to-Surgery Time Interval in Stage I NSCLC
Posted: Tuesday, May 8, 2018
Weeks matter enormously when scheduling surgery after confirmed clinical staging of stage I non–small-cell lung cancer (NSCLC), according to the results of an extensive study led by thoracic surgeon Harmik J. Soukiasian, MD, of Cedars-Sinai Health System, Los Angeles. He presented his team’s findings on how surgery delays may affect eventual upstaging—and progression and likelihood of cure—at the 2018 American Association for Thoracic Surgery (AATS) Annual Meeting (Abstract 67).
In an AATS news release, Dr. Soukiasian was blunt: “An astonishing number of clinical stage I NSCLC patients upstaged to 3A disease at the time of surgery. Although current national guidelines recommend surgery within 8 weeks from diagnosis, our study demonstrates there is a benefit in doing surgery even within a week-to-week basis.”
The investigators analyzed data on 52,406 patients from the National Cancer Database. All of these patients had diagnoses of clinical stage I NSCLC, had received no chemotherapy, and had undergone anatomic lobar resection and lymphadenectomy or lymph node sampling between 1 and 12 weeks after staging.
A quarter of the cohort had surgery within a week, and of those 13,325 patients, 2,896, or 21.7%, were upstaged at surgery. Nearly 80% of patients had undergone resection by 8 weeks, and 91.2% had undergone resection by 12 weeks. For those who had surgery at 8 and 12 weeks, the upstaging rates were also significant at 31.5% and 32.6%, respectively. Furthermore, these significant trends held in subgroup analyses of stage 1A and 1B adenocarcinoma and 1A and 1B squamous cell carcinoma.
