1287 Timing of Surgery for Operable Non-Small Cell Lung Cancer and Concordance Between Clinical and Pathological Staging: The Aftermath of the Covid-19 Pandemic

Abstract

Abstract Aim The present study assessed the concordance between clinical and pathological staging of non-small cell lung cancer (NSCLC) in patients who were referred with operable tumors. Method We retrospectively reviewed case records of 123 consecutive patients with operable NSCLC, who underwent curative surgery and whose pathology was evaluated at our institution between January 1, 2021, and December 31, 2021. Histopathology reports, imaging information, and multidisciplinary (MDT) team notes were retrieved from hospital digital records. Results The cohort included 73 (59%) women and 50 (41%) men in the age range of 46-88 years (median age 73 years [IQR 67-77]). Median time interval between staging CT and surgery (91 days [IQR 76.5-117.5]), and PET and surgery (70 days [IQR 57.5-92.0]) indicated that UK guidelines of <62 days between initial referral and commencement of definitive treatment were not being met in the majority of cases. EBUS-TBNA was performed for 15 (12%) patients and the median interval between EBUS-TBNA and surgery was 44 days (IQR 41.0-66.5). Discordant clinical and pathological TNM staging was evident in 65% of cases, including 45% of clinically understaged cases; and four patients with undetected pT4 disease. Six tumors staged postoperatively as N1 had been staged clinically as N0. For five cases with unforeseen N2, clinical staging was N0; surgery might not have been necessary for these patients. Conclusions Discordance between clinical and pathological staging of NSCLC is associated with treatment delays. Reduced time interval between staging CT/PET and surgery may have avoided inappropriate resections.