Survival differences in surgically eligible and ineligible patients treated for early-stage non-small cell lung cancer (nsclc): results from a population-based registry

SESSION TITLE: Updates in Lung Cancer SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: To compare the overall survival (OS) of early-stage non-small cell lung cancer (NSCLC) patients who were treated surgically to those who were ineligible for or declined surgery and thus received non-surgical treatments. METHODS: Patients ≥ 66 years of age with newly diagnosed stage 0/I NSCLC (AJCC 8th ed) were identified from the Surveillance, Epidemiology and End Results Program (SEER) Medicare linked data from 2006-2017. Surgically treated patients were identified as those who underwent surgery as first-line monotherapy without any other treatment modalities within 45 days prior and 180 days post-diagnosis. Surgically ineligible patients included those who had no thoracic surgery and a record that indicated surgery was not performed/not recommended by the treating physician and/or refused by patients. Surgically ineligible patients receiving radiation therapy and ablation were included; patients who received no treatment or chemotherapy alone in the prespecified treatment window were excluded. The Kaplan-Meier method was used to estimate OS from the index NSCLC diagnosis for each group, stratified by tumor size. RESULTS: A total of 31,579 early-stage NSCLC patients were identified; 22,420 (70.9%) underwent surgery and 9,159 (29.1%) were treated non-surgically. Compared to patients who underwent surgery, surgically ineligible patients were older (mean age 78.5 years vs. 74.9 years; p<0.01), less likely to have tumors ≤2cm (44.5% vs. 52.1%; p<0.01) and had a higher prevalence of chronic obstructive pulmonary disease (69.7% vs. 50.0%; p<0.01). The 1, 2, and 5-year OS rates in surgery and surgically ineligible groups were 91.7% (95% confidence interval [CI]: 91.3%-92.1%), 83.9% (95% CI: 83.4%-84.4%), and 61.9% (95% CI: 61.2%-62.6%), vs. 83.7% (95% CI: 82.9%-84.5%), 63.7% (95% CI: 62.7%-64.7%), and 28.4% (95% CI: 27.3%-29.5%), respectively. The absolute differences in OS between the two groups at 1, 2, and 5 years were 8.0%, 20.2%, and 33.5%, respectively. In the first 2 years, survival differences between the two groups increased with larger baseline tumor sizes; 1 and 2-year OS differences were 5.8% and 16.3%; 7.3% and 19.7%; and 12.8% and 27.6% for patients with tumor sizes ≤2cm, >2-3cm, and >3-4cm, respectively. Variations in 5-year OS based on tumor size was not observed. CONCLUSIONS: Among early-stage NSCLC patients, OS in surgically treated patients was significantly higher than non-surgically treated patients (radiation and ablation), with absolute difference in OS ranging from 8% at 1 year to 33.5% at 5 years. CLINICAL IMPLICATIONS: The OS data for early-stage NSCLC patients stratified by surgical eligibility and tumor size can provide benchmarks for clinicians and researchers. This study also lays the foundation for additional research around drivers of the short-term and long-term differences in OS between surgical and non-surgical treatment options. DISCLOSURES: Employee relationship with Johnson and Johnson Please note: 2015 - Present by Iftekhar Kalsekar, value=Salary No disclosure on file for Paul Laeseke Employee relationship with Johnson & Johnson Please note: 9/2020 - Present Added 03/23/2023 by Balaji Laxmanan, source=Web Response, value=Salary Advisory Committee Member relationship with Medtronic Please note: 2020-present Added 12/05/2022 by Calvin Ng, value=Honoraria Advisory Committee Member relationship with Johnson and Johnson Please note: 2013-present Added 12/05/2022 by Calvin Ng, value=Honoraria Consultant relationship with Astra Zeneca Please note: 2021-present Added 12/04/2022 by Calvin Ng, source=Web Response, value=Honoraria Speaker relationship with Intuitive Please note: Since December 2019 by Michael Pritchett, value=Consulting fee Consultant relationship with Medtronic Please note: Since 2014 by Michael Pritchett, value=Consulting fee Consultant relationship with Johnson&Johnson Please note: Since December 2018 by Michael Pritchett, value=Consulting fee Consultant relationship with Philips Please note: Since 2019 by Michael Pritchett, value=Consulting fee Employee relationship with Johnson & Johnson Please note: 2007-present by Philippe Szapary, value=Salary No relevant relationships by Charlene Wong Employee relationship with Johnson & Johnson Please note: Sept 2019 to present by Meijia Zhou, value=Salary