High-Risk Early-Stage Lung Cancer Patients Fare Well With Surgery

Early-stage lung cancer patients considered to be high risk for surgery can achieve good clinical outcomes with surgical resection, according to a new study. This suggests that empiric selection criteria may deny some patients the best possible therapy.

One of five patients with stage I NSCLC is deemed inoperable thanks to age and comorbidities, according to authors led by Manu S. Sancheti, MD, of Emory University in Atlanta. “The survival with untreated stage I NSCLC is dismal. Thus the importance in elucidating an effective treatment plan for these patients cannot be overstated,” they wrote.

The new study examined outcomes among 490 patients who underwent resection for clinical stage I lung cancer from 2009 to 2013. Of those patients, 180 (37%) were deemed to be high-risk based on American College of Surgery Oncology Group (ACOSOG) criteria. The results of the analysis were published online ahead of print in Annals of Thoracic Surgery.

The patients found to be high risk were older than standard-risk patients, with a median age of 70 years vs 65 years (P < .0001). They also had worse forced expiratory volume in 1 second (57% vs 85%; P < .0001) and diffusing capacity of lung for carbon monoxide (47% vs 77%; P < .0001). High-risk patients had more smoking pack-years than standard-risk patients (46 vs 30; P < .0001) and a higher incidence of chronic obstructive pulmonary disease (72% vs 32%; P < .0001). They were also more likely to undergo sublobar resection (32% vs 20%; P = .001).

The length of hospital stay was greater among high-risk patients, at 5 vs 4 days (P < .0001), but there was no difference with regard to postoperative mortality (2% vs 1%; P = .53). There was also no difference with regard to nodal upstaging between the two groups, with 20% for high-risk patients and 21% for standard-risk patients (P = .79).

The high-risk group did have poorer 3-year survival than the standard-risk group, at 59% vs 77%, for a hazard ratio of 2.42 (95% confidence interval [CI], 1.50–3.89; P < .01).

“Our analysis demonstrates an acceptable operative risk and survival for lobal and sublobar resections in these patients who meet ACOSOG criteria for high risk,” the authors concluded. “We believe that it is the onus of thoracic surgeons to lead continued investigations into improvements in risk stratification, as well as to delineate the most efficacious treatment, with resection at the forefront.”