Treatment Attrition From Surgery to Adjuvant Therapy in Stage IIB and IIIA Lung Adenocarcinoma: A National Cancer Database Analysis

IF 3.9 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2026-06-01 Epub Date: 2026-04-28 DOI:10.1016/j.cllc.2026.04.013

Omar Bushara , Mohammad S. Farooq , Shawn Ahn, Eliana Marostica, Karina Bruestle, Giorgos Karakousis, John C. Kucharczuk, Sunil Singhal

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Abstract

Introduction

Lung cancer is the leading cause of cancer-related death. For pathologic stage IIB/IIIA tumors, standard of care may include surgery followed by adjuvant therapy. The proportion of patients who do not receive adjuvant therapy after surgery is not well-characterized. The goal of this study is to define the rate of treatment attrition from surgery to adjuvant therapy, identify factors associated with attrition, and elucidate trends in attrition from 2012 to 2022.

Methods

Patients with resected pathologic stage IIB/IIIA lung adenocarcinoma were included. Treatment attrition was defined as not receiving any adjuvant therapy after surgery. Trends were tested with Cochran-Armitage tests. Unadjusted and adjusted Cox proportional hazard models were used to analyze survival.

Results

25,436 patients had pathologic stage IIB/IIIA tumors. 16,796 (66.0%) underwent adjuvant therapy, demonstrating an attrition rate of 34.0%. Attrition decreased from 37.7% in 2012 to 25.7% in 2022 (P < .001). Patient characteristics associated with attrition were age, morbidity, stage, private insurance, and having open surgery. Adjuvant therapy was associated with improved survival in unadjusted and adjusted analyses, and retained a survival benefit throughout the time period despite a changing patient profile.

Discussion

Herein we define treatment attrition from surgery to adjuvant therapy in lung adenocarcinoma utilizing a large national cohort. The overall treatment attrition rate was 34.0%, although it significantly decreased over time. Adjuvant therapy was associated with a survival benefit, underscoring the importance of reducing treatment attrition to improve outcomes.

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IIB期和IIIA期肺腺癌从手术到辅助治疗的治疗损耗：一项国家癌症数据库分析。

肺癌是癌症相关死亡的主要原因。对于病理分期IIB/IIIA的肿瘤，标准治疗可能包括手术后的辅助治疗。术后不接受辅助治疗的患者比例尚不明确。本研究的目的是确定从手术到辅助治疗的治疗磨耗率，确定与磨耗相关的因素，并阐明2012年至2022年的磨耗趋势。方法：纳入经病理切除的IIB/IIIA期肺腺癌患者。治疗损耗被定义为术后未接受任何辅助治疗。趋势用Cochran-Armitage检验。采用未调整和调整的Cox比例风险模型分析生存率。结果：病理分期为IIB/IIIA期肿瘤25,436例。辅助治疗16796例（66.0%），损耗率34.0%。流失率从2012年的37.7%下降到2022年的25.7% （P < 0.001）。与磨损相关的患者特征包括年龄、发病率、分期、私人保险和是否进行过开放手术。在未调整和调整的分析中，辅助治疗与生存率的提高有关，尽管患者的情况发生了变化，但在整个时间段内，辅助治疗仍能保持生存率的优势。讨论：在此，我们利用一个大型的国家队列来定义肺腺癌从手术到辅助治疗的治疗损耗。总体治疗损耗率为34.0%，尽管随着时间的推移显着降低。辅助治疗与生存获益相关，强调了减少治疗损耗对改善预后的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.