Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

Heiden, Brendan T.; Eaton, D.; Chang, Su‐Hsin; Yan, Yan; Baumann, Ana A.; Schoen, Martin W.; Tohmasi, Steven; Rossetti, Nikki; Patel, Mayank R.; Kreisel, Daniel; Nava, Ruben G.; Meyers, Bryan F.; Kozower, Benjamin D.

doi:10.1001/jamasurg.2022.6826

Cited by 13 publications

(9 citation statements)

References 42 publications

(103 reference statements)

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“…Using a data set of nearly 10 000 patients from the Veterans Health Administration, H eiden et al . [ 12 ] developed a surgical quality score named VALCAN-O for patients diagnosed with resectable early-stage NSCLC. The score reflects the risk-adjusted association between five quality metrics including the surgical approach (MIS and open surgery) and the overall survival and recurrence-free survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Etienne,

Pagès,

Iquille

et al. 2024

ERJ Open Res

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IntroductionNon-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients.MethodsWe conducted a retrospective multicenter study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a FEV1 (forced expiratory volume in one second) or DLCO (diffusing lung capacity of carbon monoxide) value below 50%. Co-primary endpoints were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients.ResultsOf the 46.909 patients who met the inclusion criteria, 42.214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with pre-operative FEV1 and/or pre-operative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 [5.96%]versus1301 [3.18%];p<0.0001). In high-risk patients, minimally invasive surgery was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 [0.02–0.05], p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 [0.30–0.69], p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate to low-risk patients in general (3.10%versus3.18% respectively).ConclusionIn examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through minimally invasive surgery have a similar 90-day mortality rate as low-risk patients.

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Section: Discussionmentioning

confidence: 99%

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Etienne,

Pagès,

Iquille

et al. 2024

ERJ Open Res

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“…126 Lower survival in part may reflect less access to early detection, curative-intent surgery, and new therapies. [127][128][129][130]…”

Section: Survivalmentioning

confidence: 99%

“…Artificially inflated survival among AAPI people, as well as Hispanic and AIAN people, may also occur because these individuals are more likely to be lost to follow‐up and/or racially misclassified 126 . Lower survival in part may reflect less access to early detection, curative‐intent surgery, and new therapies 127–130 …”

Section: Selected Findingsmentioning

confidence: 99%

Lung cancer statistics, 2023

Kratzer,

Bandi,

Freedman

et al. 2024

Cancer

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Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population‐based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2‐year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant‐stage disease incidence during 2013–2019, the rate for localized‐stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%–5% annually) than in those with the lowest (by 1%–2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco‐control efforts targeted at high‐risk populations, including improved access to smoking‐cessation treatments and lung cancer screening, as well as state‐of‐the‐art treatment.

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“…Practice in the US is decentralized and variable in quality, with many surgeons failing to perform these resections to professional guideline-defined standards for lymph node yield and other quality measures . The evidence shows that most US-based lung cancer operations are suboptimal even for patients with conventionally resectable NSCLC, we should be wary of offering neoadjuvant chemoimmunotherapy to patients with dubiously resectable NSCLC that would misdirect many patients to unplanned diversion from surgery or an ill-advised surgery leading to an incomplete resection.…”

Section: Perioperative Chemoimmunotherapy and The Incremental Value O...mentioning

confidence: 99%

Rapid Advances in Resectable Non–Small Cell Lung Cancer

West,

Kim

2024

JAMA Oncol

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ImportanceA series of high-profile clinical trials for patients with resectable early-stage non–small cell lung cancer (NSCLC) have recently changed the standard of care in this setting. Specifically, studies have demonstrated statistically and clinically significant improvements in efficacy with the targeted therapy for adjuvant osimertinib in patients with resected NSCLC harboring an epidermal growth factor receptor (EGFR) genomic abnormality (GA), whereas trials with chemotherapy combined with nivolumab in the neoadjuvant setting and others testing atezolizumab or pembrolizumab as adjuvant therapy have all demonstrated improvements in event-free survival (EFS) (for neoadjuvant therapy) or disease-free survival (DFS) (for adjuvant therapy). These trials introduce many open questions about how to apply these findings in clinical practice.ObservationsTreatment with adjuvant osimertinib for 3 years was associated with significant improvement in both DFS and overall survival (OS), but the erosion of the DFS benefit after the duration of treatment ends suggests a potential value for more longitudinal treatment. The potential value of highly effective targeted therapies as adjuvant therapy for other GAs has a compelling rationale but no data at this time. Adjuvant atezolizumab or pembrolizumab, generally administered for 1 year after postoperative chemotherapy, are appropriate considerations, but only atezolizumab for patients with tumor programmed death-ligand 1 (PD-L1) levels of 50% has demonstrated a benefit in OS. Neoadjuvant chemotherapy with nivolumab offers a strong EFS benefit, a shorter interval of treatment, and radiographic and pathologic feedback for patients with resectable stage IB to IIIA NSCLC, although very recent randomized clinical trials of perioperative immunotherapy both combined with chemotherapy preoperatively and administered postoperatively highlight the debatable value of adjuvant immunotherapy after prior chemoimmunotherapy. Improved tumor shrinkage rates with neoadjuvant chemoimmunotherapy suggest the possibility that criteria for resectability may potentially be redefined in anticipation of a good response to neoadjuvant chemoimmunotherapy.Conclusions and RelevanceDevelopments in resectable NSCLC have arrived so rapidly that they have also created practical challenges of identifying optimal patients and prioritizing options among these new competing standards. In some cases, practical management requires clinical judgment and discussion with the patient to cover the gaps in prospective data. Caution should be exerted when extrapolating beyond the available data.

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Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

Cited by 13 publications

References 42 publications

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Lung cancer statistics, 2023

Rapid Advances in Resectable Non–Small Cell Lung Cancer

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