More Frequent Surveillance Following Lung Cancer Resection is Not Associated with Improved Survival
Timothy L. McMurry*1, George J. Stukenborg*1, Melisa L. Wong*2, Larry G. Kessler*3, Amanda Francescatti*4, Jessica Schumacher*5, Caprice C. Greenberg5, George Chang*6, Graham A. Colditz*7, David P. Winchester4, Daniel P. McKellar*4, David R. Jones8, Benjamin D. Kozower*7
1University of Virginia, Charlottesville, VA;2University of California, San Francisco, San Francisco, CA;3University of Washington, Seattle, WA;4American College of Surgeons, Chicago, IL;5University of Wisconsin, Madison, WI;6MD Anderson Cancer Center, Houston, TX;7Washington University in St. Louis, St. Louis, MO;8Memorial Sloan Kettering Cancer Center, New York, NY
Objectives: Surveillance guidelines following surgical resection for non-small cell lung cancer (NSCLC) vary widely and are based on expert opinion and limited evidence. This study utilizes a unique and representative United States dataset to evaluate the association between the intensity (frequency) of post-resection surveillance using computed tomography (CT) and survival.
Methods: Stages I-III NSCLC patients treated with surgical resection in the National Cancer Database were randomly selected for data augmentation. Each Commission on Cancer (CoC)-accredited hospital reevaluated records from 10 patients to document all post-surgical imaging with indication (routine surveillance, new symptoms), recurrence, new primary cancers, and survival, with 5-year follow-up (2007-2013). Patients were grouped into three CT surveillance intensity categories (3-months, 6-months and annual) consistent with current societal guidelines. Overall survival and survival following recurrence were analyzed using Cox Proportional Hazards Models.
Results: Registrars augmented data from 4,463 patients followed with surveillance CT imaging. Surveillance groups were similar with respect to age, sex, comorbidities, type of surgical resection, and tumor histology. Higher stage patients received more surveillance (P<0.001). More frequent surveillance was not associated with longer overall survival (HR for 6-month: 1.16 (0.97-1.36) and annual: 1.06 (0.86-1.31) vs. 3-month; (p-values 0.06, 0.27). More frequent imaging was also not associated with post-recurrence survival (HR: 1.02/month since imaging (0.98-1.04); p-value 0.26).
Conclusions: These nationally representative data provide evidence that more frequent post-surgical surveillance is not associated with improved survival. As the number of lung cancer survivors increases over the next decade, surveillance is an important major health care concern and expenditure.
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