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Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I–II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base

  • Radiation Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The 1998 post-operative radiotherapy meta-analysis for lung cancer showed a survival detriment associated with radiation for stage I–II resected non-small cell lung cancer (NSCLC), but has been criticized for including antiquated radiation techniques. We analyzed the National Cancer Database (NCDB) to determine the impact of radiation after margin-negative (R0) resection for stage I–II NSCLC on survival.

Methods

Adult patients from 2004 to 2014 were analyzed from the NCDB with respect to receiving radiation as part of their first course of treatment for resected stage I–II NSCLC; the primary outcome measure was overall survival.

Results

A total of 197,969 patients underwent R0 resection for stage I–II NSCLC, and 4613 received radiation. Median radiation dose was 55 Gy with a 50–60 Gy interquartile range. On adjusted analysis, treatment at a community cancer program, sublobectomy, tumor size (3–7 cm), and pN1/Nx were associated with receiving radiation (odds ratio > 1, p < 0.05). The irradiated group had shorter median survival (45.8 vs. 77.5 months, p < 0.001), and radiation was independently associated with worse overall survival (hazard ratio (HR) 1.339, 95% confidence interval (CI) 1.282–1.399). After propensity score matching, radiation remained associated with worse overall survival (HR 1.313, 95% CI 1.237–1.394, p < 0.001).

Conclusions

Radiotherapy was independently associated with worse survival after R0 resection of stage I–II NSCLC in the NCDB and was more likely to be delivered in community cancer programs.

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Acknowledgment

We are appreciative of discussion with Ying Yuan, PhD, Department of Biostatistics, MD Anderson Cancer Center. Drs. Mohamed and Fuller received funding support from the National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and the NIH/National Cancer Institute (NCI) Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program award (P50CA097007-10). Dr. Fuller received support from the Paul Calabresi Clinical Oncology Program Award (K12 CA088084-06); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD), Grant (NSF 1557679); an Elekta AB/MD Anderson Department of Radiation Oncology Seed Grant; and the Center for Radiation Oncology Research (CROR) at MD Anderson Cancer Center. Dr. Fuller has received speaker travel funding from Elekta AB. Supported in part by the NIH/NCI Cancer Center Support (Core) Grant CA016672 to the University of Texas MD Anderson Cancer Center.

Disclosure

The authors declare that they have no conflict of interest to report.

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Author notes

    Authors and Affiliations

    1. Baylor College of Medicine, Houston, TX, USA

      Todd A. Pezzi BS

    2. Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

      Abdallah S. R. Mohamed MD, MSc, Clifton D. Fuller MD, PhD, Pierre Blanchard MD, PhD, Stephen M. Hahn MD, Daniel R. Gomez MD & Stephen G. Chun MD

    3. Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt

      Abdallah S. R. Mohamed MD, MSc

    4. Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France

      Pierre Blanchard MD, PhD

    5. Department of Surgery, Abington Hospital-Jefferson Health, Abington, PA, USA

      Christopher Pezzi MD

    6. Division of Surgery, Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

      Boris Sepesi MD

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    1. Todd A. Pezzi BS
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    Correspondence to Stephen G. Chun MD.

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    Todd A. Pezzi, Abdallah S. R. Mohamed, Daniel R. Gomez, Stephen G. Chun contributed equally to this manuscript.

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    Pezzi, T.A., Mohamed, A.S.R., Fuller, C.D. et al. Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I–II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base. Ann Surg Oncol 24, 1419–1427 (2017). https://doi.org/10.1245/s10434-017-5786-6

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    • DOI: https://doi.org/10.1245/s10434-017-5786-6

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