Time to Surgery in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Defining the Optimal Diagnosis-to-Resection Interval to Reduce Mortality.

Objective: Most patient variables that impact cancer case complexity and outcomes are not modifiable pre-operatively. However, the time from diagnosis to surgical resection is fluid. This retrospective study sought to identify the optimal time from NSCLC diagnosis to surgery to reduce mortality.

Methods: We evaluated adult patients with early-stage NSCLC who underwent upfront surgical resection between 2009-2019 using institutional data. Diagnosis date was uniformly defined as the date of computed tomography (CT) that prompted diagnostic workup. We evaluated 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 post-surgery.

Results: Among 2567 early-stage patients, median time to surgery was 57.0 [IQR: 41.0-79.0] days. Five-year mortality was elevated for surgeries performed >8 (vs. <8) weeks (aHR [adjusted hazard ratio] 1.19 (95% CI: 1.06-1.33)) and >12 (vs. <12) weeks (aHR 1.31 (95% CI: 1.10-1.55)) post-diagnosis. One-year recurrence was also elevated for surgeries delayed >8 (vs. <8) (aHR: 1.25 (95% CI 0.98-1.60)) and >12 (vs. <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 is identified. Our results suggest that performing surgery within 8 weeks of CT-based clinical diagnosis may be an important heath system target for early-stage NSCLC patients.