Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer

Nirav S. Kapadia, Luca F. Valle, Julie A. George, Reshma Jagsi, Thomas A. D'Amico, Elisabeth U. Dexter, Fawn D. Vigneau, Feng Ming Kong

Research output: Contribution to journalArticle

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Abstract

Background Definitive surgical and radiation therapy (RT) treatments are evolving rapidly for stage I non-small cell lung cancer (NSCLC). We hypothesized that utilization of definitive therapies increased between 2000 and 2010 and that survival improved for stage I NSCLC patients over the same time period. Secondary objectives were determining trends in patterns of care and predictors of utilization. Methods Population-based, observational, comparative effectiveness study used Surveillance, Epidemiology, and End Results-18 data from 2000 to 2010. The main outcome measure was 2-year risk of death for stage I NSCLC. Results Between 2000 and 2010, 40,589 patients (62%) underwent surgery, 10,048 (15%) received RT, 2,130 (3%) received both surgery and RT, and 11,537 (18%) received neither surgery nor RT. Annually, the odds of receiving either definitive RT or undergoing surgery increased relative to the odds of receiving no treatment (odds ratio [OR] radiation 1.04, 95% confidence interval [CI]: 1.03 to 1.05; OR surgery 1.05, 95% CI: 1.04 to 1.05). Among surgical patients, the proportion of sublobar resections steadily increased from 12.9% to 17.9%. For all patients, the 2-year risk of death decreased by 3.5% each year (hazard ratio [HR] 0.965, 95% CI: 0.962 to 0.969), driven primarily by improved survival for surgical (annualized HR 0.959, 95% CI: 0.954 to 0.964) and RT (annualized HR 0.942, 95% CI: 0.935 to 0.949) patients. Conclusions Between 2000 and 2010, stage I NSCLC patients were more likely to receive definitive treatment with either surgery or RT, leading to a decline in the number of untreated patients. Survival also improved substantially for stage I NSCLC patients, with the largest survival improvements observed in patients undergoing definitive RT.

Original languageEnglish (US)
Pages (from-to)1881-1888
Number of pages8
JournalAnnals of Thoracic Surgery
Volume104
Issue number6
DOIs
StatePublished - Dec 1 2017

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Non-Small Cell Lung Carcinoma
Radiotherapy
Confidence Intervals
Therapeutics
Survival
Odds Ratio
Epidemiology
Outcome Assessment (Health Care)
Radiation
Population

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kapadia, N. S., Valle, L. F., George, J. A., Jagsi, R., D'Amico, T. A., Dexter, E. U., ... Kong, F. M. (2017). Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer. Annals of Thoracic Surgery, 104(6), 1881-1888. https://doi.org/10.1016/j.athoracsur.2017.06.065

Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer. / Kapadia, Nirav S.; Valle, Luca F.; George, Julie A.; Jagsi, Reshma; D'Amico, Thomas A.; Dexter, Elisabeth U.; Vigneau, Fawn D.; Kong, Feng Ming.

In: Annals of Thoracic Surgery, Vol. 104, No. 6, 01.12.2017, p. 1881-1888.

Research output: Contribution to journalArticle

Kapadia, NS, Valle, LF, George, JA, Jagsi, R, D'Amico, TA, Dexter, EU, Vigneau, FD & Kong, FM 2017, 'Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer', Annals of Thoracic Surgery, vol. 104, no. 6, pp. 1881-1888. https://doi.org/10.1016/j.athoracsur.2017.06.065
Kapadia, Nirav S. ; Valle, Luca F. ; George, Julie A. ; Jagsi, Reshma ; D'Amico, Thomas A. ; Dexter, Elisabeth U. ; Vigneau, Fawn D. ; Kong, Feng Ming. / Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer. In: Annals of Thoracic Surgery. 2017 ; Vol. 104, No. 6. pp. 1881-1888.
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abstract = "Background Definitive surgical and radiation therapy (RT) treatments are evolving rapidly for stage I non-small cell lung cancer (NSCLC). We hypothesized that utilization of definitive therapies increased between 2000 and 2010 and that survival improved for stage I NSCLC patients over the same time period. Secondary objectives were determining trends in patterns of care and predictors of utilization. Methods Population-based, observational, comparative effectiveness study used Surveillance, Epidemiology, and End Results-18 data from 2000 to 2010. The main outcome measure was 2-year risk of death for stage I NSCLC. Results Between 2000 and 2010, 40,589 patients (62{\%}) underwent surgery, 10,048 (15{\%}) received RT, 2,130 (3{\%}) received both surgery and RT, and 11,537 (18{\%}) received neither surgery nor RT. Annually, the odds of receiving either definitive RT or undergoing surgery increased relative to the odds of receiving no treatment (odds ratio [OR] radiation 1.04, 95{\%} confidence interval [CI]: 1.03 to 1.05; OR surgery 1.05, 95{\%} CI: 1.04 to 1.05). Among surgical patients, the proportion of sublobar resections steadily increased from 12.9{\%} to 17.9{\%}. For all patients, the 2-year risk of death decreased by 3.5{\%} each year (hazard ratio [HR] 0.965, 95{\%} CI: 0.962 to 0.969), driven primarily by improved survival for surgical (annualized HR 0.959, 95{\%} CI: 0.954 to 0.964) and RT (annualized HR 0.942, 95{\%} CI: 0.935 to 0.949) patients. Conclusions Between 2000 and 2010, stage I NSCLC patients were more likely to receive definitive treatment with either surgery or RT, leading to a decline in the number of untreated patients. Survival also improved substantially for stage I NSCLC patients, with the largest survival improvements observed in patients undergoing definitive RT.",
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AU - Valle, Luca F.

AU - George, Julie A.

AU - Jagsi, Reshma

AU - D'Amico, Thomas A.

AU - Dexter, Elisabeth U.

AU - Vigneau, Fawn D.

AU - Kong, Feng Ming

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N2 - Background Definitive surgical and radiation therapy (RT) treatments are evolving rapidly for stage I non-small cell lung cancer (NSCLC). We hypothesized that utilization of definitive therapies increased between 2000 and 2010 and that survival improved for stage I NSCLC patients over the same time period. Secondary objectives were determining trends in patterns of care and predictors of utilization. Methods Population-based, observational, comparative effectiveness study used Surveillance, Epidemiology, and End Results-18 data from 2000 to 2010. The main outcome measure was 2-year risk of death for stage I NSCLC. Results Between 2000 and 2010, 40,589 patients (62%) underwent surgery, 10,048 (15%) received RT, 2,130 (3%) received both surgery and RT, and 11,537 (18%) received neither surgery nor RT. Annually, the odds of receiving either definitive RT or undergoing surgery increased relative to the odds of receiving no treatment (odds ratio [OR] radiation 1.04, 95% confidence interval [CI]: 1.03 to 1.05; OR surgery 1.05, 95% CI: 1.04 to 1.05). Among surgical patients, the proportion of sublobar resections steadily increased from 12.9% to 17.9%. For all patients, the 2-year risk of death decreased by 3.5% each year (hazard ratio [HR] 0.965, 95% CI: 0.962 to 0.969), driven primarily by improved survival for surgical (annualized HR 0.959, 95% CI: 0.954 to 0.964) and RT (annualized HR 0.942, 95% CI: 0.935 to 0.949) patients. Conclusions Between 2000 and 2010, stage I NSCLC patients were more likely to receive definitive treatment with either surgery or RT, leading to a decline in the number of untreated patients. Survival also improved substantially for stage I NSCLC patients, with the largest survival improvements observed in patients undergoing definitive RT.

AB - Background Definitive surgical and radiation therapy (RT) treatments are evolving rapidly for stage I non-small cell lung cancer (NSCLC). We hypothesized that utilization of definitive therapies increased between 2000 and 2010 and that survival improved for stage I NSCLC patients over the same time period. Secondary objectives were determining trends in patterns of care and predictors of utilization. Methods Population-based, observational, comparative effectiveness study used Surveillance, Epidemiology, and End Results-18 data from 2000 to 2010. The main outcome measure was 2-year risk of death for stage I NSCLC. Results Between 2000 and 2010, 40,589 patients (62%) underwent surgery, 10,048 (15%) received RT, 2,130 (3%) received both surgery and RT, and 11,537 (18%) received neither surgery nor RT. Annually, the odds of receiving either definitive RT or undergoing surgery increased relative to the odds of receiving no treatment (odds ratio [OR] radiation 1.04, 95% confidence interval [CI]: 1.03 to 1.05; OR surgery 1.05, 95% CI: 1.04 to 1.05). Among surgical patients, the proportion of sublobar resections steadily increased from 12.9% to 17.9%. For all patients, the 2-year risk of death decreased by 3.5% each year (hazard ratio [HR] 0.965, 95% CI: 0.962 to 0.969), driven primarily by improved survival for surgical (annualized HR 0.959, 95% CI: 0.954 to 0.964) and RT (annualized HR 0.942, 95% CI: 0.935 to 0.949) patients. Conclusions Between 2000 and 2010, stage I NSCLC patients were more likely to receive definitive treatment with either surgery or RT, leading to a decline in the number of untreated patients. Survival also improved substantially for stage I NSCLC patients, with the largest survival improvements observed in patients undergoing definitive RT.

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