Surgical Resection for Stage IIIA Non-Small Cell Lung Cancer in the United States

Abstract

Controversy exists regarding the impact of surgical resection in patients with locally advanced non-small cell lung cancer (NSCLC). Our goal was to review the patterns of care of patients with stage IIIA NSCLC in the United States, with focus on socioeconomic and regional factors associated with receipt of surgical resection and its impact on overall survival (OS). The National Cancer Database was reviewed for patients 2004-2013 with stage IIIA NSCLC. Only patients receiving chemotherapy and with histologies of squamous cell carcinoma (SCC), adenocarcinoma, and NSCLC not otherwise specified were included. Univariable and multivariable (MVA) analyses were performed to investigate factors associated with receipt of surgery, as well as OS following diagnosis. After exclusions, 81,206 patients were included in this analysis, 19.1% of which underwent surgical resection. On MVA, socioeconomic and regional factors associated with an increased rate of surgical resection included treatment at an academic center (HR 1.95, p < 0.001), living within New England (p < 0.001), having private insurance (HR 2.28, p < 0.001), and having higher income (p < 0.001). On MVA, socioeconomic and regional factors associated with improved OS included treatment at an academic center (HR 0.89, p < 0.001), having private or government insurance (HR 0.89 and 0.853, respectively, each p < 0.001), receipt of radiotherapy (HR 0.75, p < 0.001), and receipt of surgery (HR 0.45, p< 0.001). In this large database analysis, several socioeconomic and regional factors impact the receipt of surgical resection in stage IIIA NSCLC. After controlling for these factors, the receipt of surgery was found to be a powerful predictor for improved OS. Future research into these disparities and additional prospective assessment of trimodality therapy are warranted.