Epidemiology, patient management, and survival outcomes in resected patients with non-metastatic non-small cell lung cancer: a nationwide real-world study.

Introduction: Surgery is the standard of care for eligible patients with localized or stage IIIA locally advanced non-small cell lung cancer (NSCLC) current guidelines recommend the most conservative surgeries possible. The aim of this study was to bring new real-world data on resected NSCLC epidemiology, management, and survival outcomes in patients with resected non-metastatic NSCLC.

Materials and methods: This is a descriptive, non-interventional, national, retrospective claims study using data from the French National Hospitalization Database (PMSI) describing the management of patients with non-metastatic NSCLC who underwent a first lung resection (LR) between 2015 and 2019. Patients with LR performed in 2015 were followed from LR until the last registered hospital care or in-hospital death. Five-year disease-free survival (DFS [i.e., time from LR to first recurrence or death]) and overall survival (OS) were assessed.

Results: The rate of patients with non-metastatic NSCLC and a first LR between 2015 and 2019 increased by an average of 4.5% per year (8,688 in 2015 vs. 10,330 in 2019). Lobectomy (79.8% vs. 84.9%) and video-assisted thoracoscopic surgery (29.6% vs. 46.4%) became more frequent. Five-year DFS was 33.7% [95%CI 29.8-37.6%] following infralobar resection, 52.3% [51.0-53.5%] after lobectomy, 42.3% [36.9-47.5%] after bilobectomy, and 33.6% [30.0-37.2%] after pneumonectomy. Respective five-year OS from LR were 58.4% [54.1-62.4], 70.2% [69.0-71.3], 59.3% [53.7-64.4], and 46.3% [42.3-50.2].

Conclusions: This study highlights the increasing trend toward conservative and less invasive surgeries in resected NSCLC. Type of LR can be used as an indirect marker of disease expansion, with poorer survival outcomes in case of extensive surgeries.