Delayed Surgery Decreases Overall Survival in Early-Stage Non-Small Cell Lung Cancer: A Propensity Matched Cohort Analysis

A. Murillo¹, L. Pierce², A. Griffin², D. Jablons², J. Kratz^2
1University of California San Francisco (UCSF), Vacaville, California ²UCSF, San Francisco, California

Purpose: There is conflicting evidence on the impact of time between diagnosis and surgery on patient survival in early-stage non-small cell lung cancer (NSCLC). This study investigated whether delayed surgical intervention after diagnosis of resectable early-stage NSCLC impacted overall survival.

Methods: We conducted a single-center retrospective cohort study using a prospectively maintained database on consecutive patients who underwent lung resection for stage I-II NSCLC with curative intent between June 2012 and February 2024. Patients who underwent neoadjuvant therapy were excluded. We identified 790 patients and separated them into two groups based on time between diagnosis and surgery, with a cutoff point of 45 days. We performed a 1:1 propensity matched analysis to reduce potential bias and used a standard mean difference of < 0.1 to indicate balance between groups. Stratified Kaplan-Meier analysis with a right-censored dataset and log-rank tests were used to assess the association between time to surgery and 10-year overall survival. Other important covariates, including age, smoking status, sex, histology, and stage, were assessed using multivariate Cox proportional hazards modeling to account for potential confounding factors. For all statistical tests, a pre-specified two-sided α of 0.05 was considered statistically significant.

Results: Our propensity matched cohort included 566 patients with 283 in each group. 10-year overall survival for the cohort was 65% (95% CI 0.59-0.71). Patients with less than 45 days between diagnosis and surgery had a 10-year overall survival of 74% (95% CI 0.66 - 0.83) compared to 54% in patients with greater than or equal to 45 days between diagnosis and surgery (95% CI 4.17- 6.90, p< 0.003, Figure). Cox hazard model analysis revealed that a delay in surgery of more than 45 days after the date of diagnosis significantly increased the risk of death (HR 1.615, [95% CI 1.102- 2.366], p=0.014) even after adjusting for age, smoking status, sex, histology, and stage. Although increased age at diagnosis also increased the risk of death, while lepidic predominance and male sex decreased the risk, time to surgery remained the most significant predictor of overall survival even after adjusting for these other clinical covariates (Table). Excluding patients with lepidic-predominant histology did not change these findings.

Conclusion: Delayed surgery after 45 days from the date of diagnosis was associated with decreased overall survival in patients undergoing lung resection for early-stage NSCLC. Efforts to improve access to timely surgery may improve overall survival for patients with early-stage disease.

Identify the source of the funding for this research project: None