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Each week that a patient with a new diagnosis of early lung cancer awaits surgery significantly increases the risk for tumor growth, spread and "upstaging," according to an analysis of thousands of patients.
Patients with stage I non-small cell lung cancer (NSCLC) had a 4% increased risk of upstaging generally (to stage II, III, or IV) each week until their surgery. Their risk of upstaging to IIIA disease was 1.3% per week of surgery delay. The findings were reported at the American Association for Thoracic Surgery meeting.
Among 52,000 stage I NSCLC patients analyzed, about a quarter underwent resection within one week of lung cancer diagnosis. However, more than 20% waited longer than eight weeks for surgery, and about one in 11 waited longer than 12 weeks.
Over 14,000 of the 52,000 patients were found to be upstaged from the time of diagnosis to the time of surgery:
- 5,506 were upstaged from stage IA to IB;
- 4,438 were upstaged from stage I to IIA;
- 1,863 from stage I to IIB;
- 2,551 from stage I to IIIA,
- 76 from stage I to IIIB.
Confounding by indication was unavoidable in this type of retrospective analysis. Oncologists and surgeons are more likely to push for early resection of more aggressive-appearing tumors. However, this bias would tend to reduce the observed rate of upstaging.
Having more mediastinal lymph nodes sampled, and undergoing surgery in an academic hospital setting each predicted upstaging. However, patients treated in academic centers had more nodes sampled on average. Referral bias or systemic variations in care could be contributory.
Upstaging can result in patients' undergoing theoretically avoidable chemotherapy and radiation. The approximately 5% of patients experiencing an upstaging from stage I to IIIA experienced a substantial decline in expected survival. The study was not designed to detect lags from patients' intentionally delaying surgery for personal reasons, or for medically appropriate delays in surgery.
National Comprehensive Cancer Network guidelines currently advise lung cancer resection surgery be performed within 8 weeks for stage I NSCLC. The report is expected to spur many medical and surgical oncologists to expedite lung cancer resection surgeries.
Source: AATS meeting abstract