- LOUIS — Surgery remains the first choice treatment for stage 1 non-small cell lung cancer (NSCLC) for patients who can withstand it. As a result, most patients with early stage disease and their physicians opt for surgery.
A new study asks: Could establishment of a surgical quality score improve their outcomes?
Researchers at the VA St. Louis Health Care System and the Washington University School of Medicine in St. Louis sought to determine whether a novel method of scoring surgical quality could improve overall and disease-free survival. To answer the question, they conducted a retrospective cohort study among veterans who underwent definitive surgical treatment for stage 1 NSCLC between 2006 and 2016. 1
Drawing on current guidelines for treatment, the team identified five surgical quality measures: timeliness, defined as within 12 weeks of diagnosis; use of a minimally invasive approach; anatomic resection via lobectomy; nodal sampling of 10 or more nodes; and negative margin. Then they used a multivariable Cox proportional hazards model to develop a surgical quality score that reflected the association between the quality metrics and overall survival and disease-free survival.
Of the 9,628 veterans who received surgical treatment during the study period, 68.9% received surgery within 12 weeks of diagnosis. Forty-one percent had surgery that used a minimally invasive approach, while 71.1% had a lobectomy. The worst performance was in sampling, where just over one-third (34.1%) had adequate (10 or more) nodes sampled. Conversely, the best performance was in achieving negative margins, which was accomplished in nearly all (96.7%) surgeries.
The team developed a normalized scoring system with 0 representing no quality metrics met and 100 representing the achievement of all the metrics. Over a median follow-up of 6.2 years (2.5 to 11.4), higher scores reflected progressively improved risk-adjusted overall survival. The median overall survival was 86.8 months (37.8 months to 149.6 months) among those in this highest-scoring quintile. The lowest quintile, in contrast, had a median overall survival of just 25.3 months (7.1 months to 45.8 months).
Just under one-quarter (23.6%) of patients experienced a recurrence of their lung cancer. Disease-free survival was associated with higher surgical quality score. “Adherence to intra-operative [quality metrics] is associated with markedly improved overall and disease-free survival,” the researchers noted. “Efforts to improve adherence to surgical [quality metrics] can dramatically improve patient outcomes following curative-intent resection of early-stage lung cancer.”
- Heiden B, Eaton DB, Chang SH, Yan Y, Schoen MS, Meyers BF, Kozower BD, Pur V. Intraoperative quality metrics and association with survival following lung cancer resection. J Clin Oncol 40, 2022 (suppl 16; abstr 8502)
