Time to surgery in early-stage non-small cell lung cancer: Defining the optimal diagnosis-to-resection interval to reduce mortality

Background: Most patient variables that impact cancer case complexity and outcomes are not modifiable preoperatively; however, the time from diagnosis to surgical resection is fluid. This retrospective study sought to identify the optimal interval from diagnosis of non-small cell lung cancer (NSCLC) to surgery to reduce mortality.

Methods: We evaluated adult patients with early-stage NSCLC who underwent upfront surgical resection between 2009 and 2019 using institutional data. The date of NSCLC diagnosis was defined uniformly as the date of a computed tomography (CT) scan that prompted a diagnostic workup. We evaluated the time to surgery in 2-week intervals. Using Cox regression analysis with adjustment for key patient sociodemographic, clinical, and cancer characteristics, we examined time to surgery associations with recurrent/new lung cancer and overall mortality at 1 and 5 years after surgery.

Results: Among 2567 early-stage NSCLC patients, the median time to surgery was 57.0 days (interquartile range, 41.0-79.0 days). Five-year mortality was elevated for surgeries performed at >8 weeks versus those performed at ≤8 weeks (adjusted hazard ratio [aHR], 1.19; 95% confidence interval [CI], 1.06-1.33) and at >12 weeks versus ≤12 weeks (aHR, 1.31; 95% CI, 1.10-1.55) after diagnosis. The rate of 1-year recurrence was also elevated for surgeries delayed for >8 weeks versus ≤8 weeks (aHR, 1.25; 95% CI, 0.98-1.60) and for >12 weeks versus ≤12 weeks (aHR, 1.62; 95% CI, 1.12-2.36).

Conclusions: Although NSCLC aggressiveness varies, quality metrics for time to surgery are needed to optimize outcomes. This will be increasingly important as more early-stage, resectable NSCLC cases are identified. Our results suggest that performing surgery within 8 weeks of CT-based clinical diagnosis may be an important health system target for early-stage NSCLC patients.