Time to surgery in early-stage non–small cell lung cancer: Defining the optimal diagnosis-to-resection interval to reduce mortality

Background

Most patient variables that impact cancer case complexity and outcomes are not modifiable preoperatively; however, the time from diagnosis to surgical resection is fluid. This retrospective study sought to identify the optimal interval from diagnosis of non–small cell lung cancer (NSCLC) to surgery to reduce mortality.

Methods

We evaluated adult patients with early-stage NSCLC who underwent upfront surgical resection between 2009 and 2019 using institutional data. The date of NSCLC diagnosis was defined uniformly as the date of a computed tomography (CT) scan that prompted a diagnostic workup. We evaluated the time to surgery in 2-week intervals. Using Cox regression analysis with adjustment for key patient sociodemographic, clinical, and cancer characteristics, we examined time to surgery associations with recurrent/new lung cancer and overall mortality at 1 and 5 years after surgery.

Results

Among 2567 early-stage NSCLC patients, the median time to surgery was 57.0 days (interquartile range, 41.0-79.0 days). Five-year mortality was elevated for surgeries performed at >8 weeks versus those performed at ≤8 weeks (adjusted hazard ratio [aHR], 1.19; 95% confidence interval [CI], 1.06-1.33) and at >12 weeks versus ≤12 weeks (aHR, 1.31; 95% CI, 1.10-1.55) after diagnosis. The rate of 1-year recurrence was also elevated for surgeries delayed for >8 weeks versus ≤8 weeks (aHR, 1.25; 95% CI, 0.98-1.60) and for >12 weeks versus ≤12 weeks (aHR, 1.62; 95% CI, 1.12-2.36).

Conclusions

Although NSCLC aggressiveness varies, quality metrics for time to surgery are needed to optimize outcomes. This will be increasingly important as more early-stage, resectable NSCLC cases are identified. Our results suggest that performing surgery within 8 weeks of CT-based clinical diagnosis may be an important health system target for early-stage NSCLC patients.