Surgical outcomes for early-stage non-small cell lung cancer at facilities with stereotactic body radiation therapy programs.

Authors

null

Yusef Syed

Emory University, Atlanta, GA

Yusef Syed , William A. Stokes , Onkar Khullar , Nikhil Sebastian , Manali Rupji , Liu Yuan , Jeffrey D. Bradley , Kristin Ann Higgins , Walter J Curran , Suresh S. Ramalingam , Manu Sancheti , Felix Fernandez , Drew Moghanaki

Organizations

Emory University, Atlanta, GA, Emory University School of Medicine, Atlanta, GA, Emory University Hospital Midtown, Atlanta, GA, Winship Cancer Institute, Emory University, Atlanta, GA, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, Winship Cancer Institute of Emory University, Atlanta, GA, Atlanta Veterans Affairs Health Care System, Decatur, GA

Research Funding

No funding received
None

Background: Patients undergoing surgery for early-stage non-small cell lung cancer (NSCLC) may be at high-risk for post-operative mortality. Access to stereotactic body radiation therapy (SBRT) offers a less invasive alternative for this population that may facilitate more appropriate patient selection for surgery. Methods: An analysis of all patients with early-stage NSCLC reported to the National Cancer Database between 2004-2015 was performed. Post-operative mortality rates were derived using vital status data. Utilization of SBRT was defined by each facility’s SBRT Experience in years and SBRT-to-Surgery volume ratios, defined by quartiles. Multivariable logistic regression with backward elimination was used to test for independence of associations between exposures of interest and post-operative mortality. Interaction testing was performed to assess the statistical relationship of covariates found to have independent associations. Results: The study cohort consisted of 202,542 patients who underwent surgical resection of clinical stage T1-T2 NSCLC (AJCC 7th edition). The 90-day post-operative mortality rate declined significantly during the study period from 4.6% to 2.6% (p < 0.001). During this period, the proportion of facilities that utilized SBRT increased from 3.3% to 77.5% (p < 0.001) and the proportion of patients treated with SBRT increased significantly from 0.7% to 15.4% (p < 0.001). Lower 90-day post-operative mortality rates were observed at facilities with greater than six years of SBRT experience (OR 0.84, CI 0.76-0.94, p = 0.003) and SBRT-to-Surgery volume ratios above 17% (OR 0.85, CI 0.79-0.92, p < 0.001). Additional covariates associated with 90-day mortality included higher surgical volume, geographic region, year of diagnosis, age, sex, race, insurance status, facility type, Charlson-Deyo score, clinical T stage, histology, anatomic location, surgery type, and prior malignancy. Interaction testing between these covariates was negative, demonstrating that higher SBRT Experience and SBRT-to-Surgery volume ratios were independently associated with lower 90-day surgical mortality. Conclusions: Patients who underwent surgery for early-stage NSCLC at facilities with higher SBRT Experience and SBRT-to-Surgery volume ratios had lower rates of post-operative mortality. These findings suggest that the availability of SBRT may be a surrogate for a more comprehensive and safer approach to matching patients to surgery or SBRT. The observation of higher post-operative mortality rates at facilities without an SBRT program deserves further study.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 8538)

DOI

10.1200/JCO.2021.39.15_suppl.8538

Abstract #

8538

Poster Bd #

Online Only

Abstract Disclosures

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