Time Trend Analysis of Perioperative and Long-Term Survival Outcomes in Patients Undergoing Resection for Non-Small Cell Lung Cancer

Jitesh Baban Shewale, The University of Texas School of Public Health

Abstract

Advances in perioperative and operative management hold great promise for improving perioperative and survival outcomes in patients undergoing resection for early-stage non-small cell lung cancer (NSCLC). The objective of this study was to evaluate time trends in the incidence of perioperative and survival outcomes, and to identify predictors of perioperative pulmonary complication and overall survival (OS), in early-stage NSCLC resection patients. An institutional database was reviewed to identify patients with primary, clinical stage I and II NSCLC who underwent resection from 1998 to 2016. Rates of pulmonary complication, pneumonia, cardiovascular complication, and 30-day and 90-day mortality (1998-2016); 3-year OS (1998-2014); and 5-year OS (1998-2012) were calculated for each year. Joinpoint regression was used to calculate annual percentage change (APC) and to evaluate time trends in these perioperative and survival outcomes. Multivariable logistic regression was conducted to identify predictors of pulmonary complication. Multivariable Cox regression was conducted to identify predictors of OS. There was no trend in the incidence of pulmonary complication, but there was a downward trend in the incidence of pneumonia (APC = -3.7), cardiovascular complication (APC = -3.5), 30-day mortality (APC = -9.8), and 90-mortality (APC = -7.4). There was a significant upward trend in rates of 3-year OS (APC= 1.8) and 5-year OS (APC= 3.1). Older age, male sex, smoking history, FEV1% predicted and perioperative blood transfusion were identified as predictors of pulmonary complication. Older age; male sex; history of diabetes, coronary artery disease, chronic obstructive pulmonary disease, or prior cancer; current smoking; high-grade tumor; squamous cell carcinoma; pneumonectomy; neoadjuvant therapy; pathological N1, N2, and M1 stage; and positive tumor margin were predictors of poor OS. Improvement in perioperative and survival outcomes parallels advances in preoperative and operative management of early-stage NSCLC resection patients. Predictors of pulmonary complication and overall survival could be used to refine selection criteria for lung resection, to reduce the incidence of pulmonary complication and to improve overall survival in these patients.

Subject Area

Surgery|Epidemiology|Oncology

Recommended Citation

Shewale, Jitesh Baban, "Time Trend Analysis of Perioperative and Long-Term Survival Outcomes in Patients Undergoing Resection for Non-Small Cell Lung Cancer" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10845152.
https://digitalcommons.library.tmc.edu/dissertations/AAI10845152

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