Imaging surveillance and survival for surgically resected non–small-cell lung cancer

Abstract

Introduction The importance of imaging surveillance following treatment for lung cancer is not well characterized. We examined the association between initial guideline recommended imaging surveillance and survival among early stage resected NSCLC patients. Methods A retrospective study was conducted using SEER-Medicare data (1995–2010). Surgically resected patients, with Stage I and II NSCLC, were categorized by imaging received during the initial surveillance period (4–8 months) following surgery. Primary outcome was overall survival. Secondary treatment interventions were examined as intermediary outcomes. Results The majority (88%) of patients had at least one outpatient clinic visit, and 24% received an initial CT during the first surveillance period. Five-year survival by initial surveillance imaging was 61% for CT, 58% for CXR, and 60% for no imaging. Following adjustment, initial CT was not associated with improved overall survival (HR 1.04; 95% CI 0.96,1.14). On subgroup analysis, restricted to patients with demonstrated initial post-operative follow-up, CT was associated with a lower overall risk of death for Stage I patients (HR 0.85; 95% CI 0.74–0.98), but not for Stage II (HR 1.01; 95% CI 0.71–1.42). There was no significant difference in rates of secondary interventions predicted by type of initial imaging surveillance. Conclusions Initial surveillance CT is not associated with improved overall or lung cancer specific survival among early stage NSCLC patients undergoing surgical resection. Stage I patients with early follow-up may represent a subpopulation that benefits from initial surveillance although this may be influenced by healthy patient selection bias.

Post-treatment Surveillance for Stage I and II Non-small Cell Lung Cancer: Impact on Clinical Outcome

“…Unfortunately, there is no statistical analysis about the added value of a CT scan above chest radiography. A second outcome, on subgroup analysis, showed that patients with stage I NSCLC might have benefits from initial surveillance with CT scan in contrast to patients with stage II (17). Comparison with this study is not easy because our study focused on the whole period of follow-up until progression of disease instead of the initial surveillance and included both surgical and SBRT patients instead of only surgical patients.…”

“…One study showed that the way of follow-up in the initial phase after surgery (4-8 months) resulted in a 5-year survival of 58% for a chest radiography versus 61% for a CT scan (17). An initial CT scan did not give a superior 5-year survival compared to no initial imaging (p=0.110).…”

Clinical Impact of Frequent Surveillance Imaging in the First Year Following Chemoradiation for Locally Advanced Non–small-cell Lung Cancer

“…Backhas et al analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, evaluating imaging studies performed during a designated surveillance window of 4–8 months following surgical resection of lung cancer. They identified no difference in overall or lung cancer-specific survival in patients who underwent an imaging study during the specified window and those who did not [15]. A systematic review analyzing the survival benefit of CT following surgery for lung cancer identified 5 relevant papers, 3 of which identified a survival benefit to surveillance CT and 2 of which did not.…”

Surveillance Practice Patterns After Curative Intent Therapy for Stage I Non-small Cell Lung Cancer in the Medicare Population

“…[12,13] A meta-analysis suggested a slight mortality benefit to surveillance, but cautioned against drawing definitive conclusions given the wide range of study designs. [63] In a recent analysis of surgically treated early stage NSCLC patients, stage I patients who received early follow-up had significantly improved 5-year survival, [64] but whether ongoing surveillance over the entire recommended two-year post-treatment period was associated with improved survival was not assessed.…”