Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

Pamela Samson, Traves D. Crabtree, Cliff G. Robinson, Daniel Morgensztern, Stephen Broderick, A. Sasha Krupnick, Daniel Kreisel, G. Alexander Patterson, Bryan Meyers, Varun Puri

Research output: Contribution to journalArticle

Abstract

Background Induction therapy leads to significant improvement in survival for selected patients with stage IIIA non-small cell lung cancer. The ideal time interval between induction therapy and surgery remains unknown. Methods Clinical stage IIIA non-small cell lung cancer patients receiving induction therapy and surgery were identified in the National Cancer Database. Delayed surgery was defined as greater than or equal to 3 months after starting induction therapy. A logistic regression model identified variables associated with delayed surgery. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to evaluate variables independently associated with overall survival. Results From 2006 to 2010, 1,529 of 2,380 (64.2%) received delayed surgery. Delayed surgery patients were older (61.2 ± 10.0 years versus 60.3 ± 9.2; p = 0.03), more likely to be non-white (12.4% versus 9.7%; p = 0.046), and less likely to have private insurance (50% versus 58.2%; p = 0.002). Delayed surgery patients were also more likely to have a sublobar resection (6.3% versus 2.9%). On multivariate analysis, age greater than 68 years (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.1 to 1.7) was associated with delayed surgery, whereas white race (OR, 0.75; 95% CI, 0.57 to 0.99) and private insurance status (OR, 0.82; 95% CI, 0.68 to 0.99) were associated with early surgery. Delayed surgery was associated with higher risk of long-term mortality (hazard ratio, 1.25; 95% CI, 1.07 to 1.47). Conclusions Delayed surgery after induction therapy for stage IIIA lung cancer is associated with shorter survival, and is influenced by both social and physiologic factors. Prospective work is needed to further characterize the relationship between patient comorbidities and functional status with receipt of timely surgery.

Original languageEnglish (US)
Pages (from-to)1070-1075
Number of pages6
JournalAnnals of Thoracic Surgery
Volume103
Issue number4
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Therapeutics
Confidence Intervals
Odds Ratio
Survival
Logistic Models
Insurance Coverage
Kaplan-Meier Estimate
Insurance
Comorbidity
Lung Neoplasms
Multivariate Analysis
Databases
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer. / Samson, Pamela; Crabtree, Traves D.; Robinson, Cliff G.; Morgensztern, Daniel; Broderick, Stephen; Krupnick, A. Sasha; Kreisel, Daniel; Patterson, G. Alexander; Meyers, Bryan; Puri, Varun.

In: Annals of Thoracic Surgery, Vol. 103, No. 4, 01.04.2017, p. 1070-1075.

Research output: Contribution to journalArticle

Samson, P, Crabtree, TD, Robinson, CG, Morgensztern, D, Broderick, S, Krupnick, AS, Kreisel, D, Patterson, GA, Meyers, B & Puri, V 2017, 'Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer', Annals of Thoracic Surgery, vol. 103, no. 4, pp. 1070-1075. https://doi.org/10.1016/j.athoracsur.2016.09.053
Samson, Pamela ; Crabtree, Traves D. ; Robinson, Cliff G. ; Morgensztern, Daniel ; Broderick, Stephen ; Krupnick, A. Sasha ; Kreisel, Daniel ; Patterson, G. Alexander ; Meyers, Bryan ; Puri, Varun. / Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 4. pp. 1070-1075.
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abstract = "Background Induction therapy leads to significant improvement in survival for selected patients with stage IIIA non-small cell lung cancer. The ideal time interval between induction therapy and surgery remains unknown. Methods Clinical stage IIIA non-small cell lung cancer patients receiving induction therapy and surgery were identified in the National Cancer Database. Delayed surgery was defined as greater than or equal to 3 months after starting induction therapy. A logistic regression model identified variables associated with delayed surgery. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to evaluate variables independently associated with overall survival. Results From 2006 to 2010, 1,529 of 2,380 (64.2{\%}) received delayed surgery. Delayed surgery patients were older (61.2 ± 10.0 years versus 60.3 ± 9.2; p = 0.03), more likely to be non-white (12.4{\%} versus 9.7{\%}; p = 0.046), and less likely to have private insurance (50{\%} versus 58.2{\%}; p = 0.002). Delayed surgery patients were also more likely to have a sublobar resection (6.3{\%} versus 2.9{\%}). On multivariate analysis, age greater than 68 years (odds ratio [OR], 1.37; 95{\%} confidence interval [CI], 1.1 to 1.7) was associated with delayed surgery, whereas white race (OR, 0.75; 95{\%} CI, 0.57 to 0.99) and private insurance status (OR, 0.82; 95{\%} CI, 0.68 to 0.99) were associated with early surgery. Delayed surgery was associated with higher risk of long-term mortality (hazard ratio, 1.25; 95{\%} CI, 1.07 to 1.47). Conclusions Delayed surgery after induction therapy for stage IIIA lung cancer is associated with shorter survival, and is influenced by both social and physiologic factors. Prospective work is needed to further characterize the relationship between patient comorbidities and functional status with receipt of timely surgery.",
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T1 - Defining the Ideal Time Interval Between Planned Induction Therapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

AU - Samson, Pamela

AU - Crabtree, Traves D.

AU - Robinson, Cliff G.

AU - Morgensztern, Daniel

AU - Broderick, Stephen

AU - Krupnick, A. Sasha

AU - Kreisel, Daniel

AU - Patterson, G. Alexander

AU - Meyers, Bryan

AU - Puri, Varun

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N2 - Background Induction therapy leads to significant improvement in survival for selected patients with stage IIIA non-small cell lung cancer. The ideal time interval between induction therapy and surgery remains unknown. Methods Clinical stage IIIA non-small cell lung cancer patients receiving induction therapy and surgery were identified in the National Cancer Database. Delayed surgery was defined as greater than or equal to 3 months after starting induction therapy. A logistic regression model identified variables associated with delayed surgery. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to evaluate variables independently associated with overall survival. Results From 2006 to 2010, 1,529 of 2,380 (64.2%) received delayed surgery. Delayed surgery patients were older (61.2 ± 10.0 years versus 60.3 ± 9.2; p = 0.03), more likely to be non-white (12.4% versus 9.7%; p = 0.046), and less likely to have private insurance (50% versus 58.2%; p = 0.002). Delayed surgery patients were also more likely to have a sublobar resection (6.3% versus 2.9%). On multivariate analysis, age greater than 68 years (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.1 to 1.7) was associated with delayed surgery, whereas white race (OR, 0.75; 95% CI, 0.57 to 0.99) and private insurance status (OR, 0.82; 95% CI, 0.68 to 0.99) were associated with early surgery. Delayed surgery was associated with higher risk of long-term mortality (hazard ratio, 1.25; 95% CI, 1.07 to 1.47). Conclusions Delayed surgery after induction therapy for stage IIIA lung cancer is associated with shorter survival, and is influenced by both social and physiologic factors. Prospective work is needed to further characterize the relationship between patient comorbidities and functional status with receipt of timely surgery.

AB - Background Induction therapy leads to significant improvement in survival for selected patients with stage IIIA non-small cell lung cancer. The ideal time interval between induction therapy and surgery remains unknown. Methods Clinical stage IIIA non-small cell lung cancer patients receiving induction therapy and surgery were identified in the National Cancer Database. Delayed surgery was defined as greater than or equal to 3 months after starting induction therapy. A logistic regression model identified variables associated with delayed surgery. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to evaluate variables independently associated with overall survival. Results From 2006 to 2010, 1,529 of 2,380 (64.2%) received delayed surgery. Delayed surgery patients were older (61.2 ± 10.0 years versus 60.3 ± 9.2; p = 0.03), more likely to be non-white (12.4% versus 9.7%; p = 0.046), and less likely to have private insurance (50% versus 58.2%; p = 0.002). Delayed surgery patients were also more likely to have a sublobar resection (6.3% versus 2.9%). On multivariate analysis, age greater than 68 years (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.1 to 1.7) was associated with delayed surgery, whereas white race (OR, 0.75; 95% CI, 0.57 to 0.99) and private insurance status (OR, 0.82; 95% CI, 0.68 to 0.99) were associated with early surgery. Delayed surgery was associated with higher risk of long-term mortality (hazard ratio, 1.25; 95% CI, 1.07 to 1.47). Conclusions Delayed surgery after induction therapy for stage IIIA lung cancer is associated with shorter survival, and is influenced by both social and physiologic factors. Prospective work is needed to further characterize the relationship between patient comorbidities and functional status with receipt of timely surgery.

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