Multidisciplinary Treatment for Stage IIIA Non-Small Cell Lung Cancer: Does Institution Type Matter?

Abstract

Background Improved survival of patients with early-stage non-small cell lung cancer (NSCLC) undergoing resection at high-volume centers has been reported. However, the effect of institution is unclear in stage IIIA NSCLC, where a variety of neoadjuvant and adjuvant therapies are used. Methods Treatment and outcomes data of clinical stage IIIA NSCLC patients undergoing resection as part of multimodality therapy was obtained from the National Cancer Database. Multivariable regression models were fitted to evaluate variables influencing 30-day mortality and overall survival. Results From 1998 to 2010, 11,492 clinical stage IIIA patients underwent resection at community centers, and 7,743 patients received resection at academic centers. Academic center patients were more likely to be younger, female, non-Caucasian, have a lower Charlson-Deyo comorbidity score, and to receive neoadjuvant chemotherapy (49.6% vs 40.6%; all p < 0.001). Higher 30-day mortality was associated with increasing age, male gender, preoperative radiotherapy, and pneumonectomy. Patients undergoing operations at academic centers experienced lower 30-day mortality (3.3% vs 4.5%; odds ratio, 0.75; 95% confidence interval [CI], 0.60 to 0.93; p < 0.001). Decreased long-term survival was associated with increasing age, male gender, higher Charlson-Deyo comorbidity score, and larger tumors. Neoadjuvant chemotherapy (hazard ratio, 0.66; 95% CI, 0.62 to 0.70), surgical intervention at an academic center (hazard ratio, 0.92; 95% CI, 0.88 to 0.97), and lobectomy (hazard ratio, 0.72; 95% CI, 0.67 to 0.77) were associated with improved overall survival. Conclusions Stage IIIA NSCLC patients undergoing resection at academic centers had lower 30-day mortality and increased overall survival compared with patients treated at community centers, possibly due to higher patient volume and an increased rate of neoadjuvant chemotherapy.

Survival trends among non‐small‐cell lung cancer patients over a decade: impact of initial therapy at academic centers

“…In a separate study based on Florida Cancer Data System, patients undergoing curative intent lung cancer resection at teaching centers and high‐volume centers had improved 30‐day (2.7% vs 1.6%, P < 0.001), 90‐day (7.5% vs 4.0%, P < 0.001), and 5‐year (63.5% vs 59.3%, P = 0.002) mortality . Samson et al showed lower 30‐day mortality of stage 3A NSCLC patients treated at academic centers based on NCDB dataset 1998‐2010 . Quality of surgery is also influenced by hospital case volume.…”

“…11 Samson et al showed lower 30-day mortality of stage 3A NSCLC patients treated at academic centers based on NCDB dataset 1998-2010. 12 Quality of surgery is also influenced by hospital case volume. Analysis of lung cancer patients undergoing lobectomy or pneumonectomy from the national Medicare database (1998-1999) showed operative mortality was lowest for the patients operated by noncardiac thoracic surgeon with high case volume.…”

Health care disparities among octogenarians and nonagenarians with stage III lung cancer

“…37 To the best of our knowledge, the current study also is the first to confirm in a population of elderly patients with lung cancer that those patients treated at an academic center were more likely to receive CRT and experience improved OS, which previous series have suggested in younger populations. 38,39 The current study series has several strengths and limitations. The major strength of this series was its sample size; to the best of our knowledge, it is the largest study conducted to date of octogenarians and nonagenarians with stage III NSCLC.…”

Pneumonectomy for Non–Small Cell Lung Cancer

“…Pneumonectomy, when part of a multimodal approach, has been shown to offer improved encouraging long term survival rates in selected patients with N2 disease. 13,[15][16][17][18][19] Neoadjuvant chemotherapy and radiation are not recommended as treatment options for early to intermediate stage lung cancer. 7,12 However, neoadjuvant chemoradiation has been shown as an effective tool to achieve regression of N2 nodes.…”

“…12 Locally advanced lung cancers (IIIA and IIIB) are also amenable to surgical resection in select groups using a multimodal approach to therapy. [13][14][15] Pneumonectomy for non-SCLC is usually indicated when tumors are located centrally and invading vascular structures or the proximal bronchus, or when part of a multimodal approach to locally advanced tumors. Pneumonectomy, when part of a multimodal approach, has been shown to offer improved encouraging long term survival rates in selected patients with N2 disease.…”