Importance of avoiding surgery delays after initial discovery of suspected non-small-cell lung cancer in clinical stage IA patients

Figures & data

Figure 1 Schematic illustration of the inclusion criteria for this study.

Figure 2 Histogram of enrolled patients and the therapeutic outcomes.

Notes: (A) The therapeutic prognosis corresponded to disease-free survival based on the longest intervals (>84 months [6 years]). Black bars: HR of overall survival in each pathological size with significance *P<0.05; gray bars: non-significant. (B) The time period between the first detection of suspected non-small-cell lung cancer opacities and the date of pulmonary resection. Black bars: shorter-interval surgery group (SISG) and gray bars: longer-interval surgery group (LILG).

Table 1 Characteristics of patients

Variables	SISG (N=121)	DSG (N=172)	P-value
Age (years), median (range)	67 (37–86)	67 (32–86)	0.82
Gender (male/female), n	69/52	83/89	0.14
Tobacco (pack-year), mean ± SD	29.3±35.1	20.3±31.6	0.02*
CEA (ng/mL, mean ± SD)	3.3±3.6	3.3±4.5	0.19
CT findings, mean ± SD
CT consolidation ratio (%)	67.6±30.8	61.4±30.3	0.08
Mediastinal diameter (mm)	10.2±8.2	7.9±7.3	0.02*
Tumor size (mm)	20.1±7.8	18.9±7.2	0.24
Doubling tumoral time (months)	155.8±317.2	405.7±902.4	<0.01*
SUV max on PET, mean ± SD	5.8±4.5	4.5±4.4	0.10
History of malignancy, yes, n (%)	45 (37.2)	95 (55.2)	<0.01*
Lung cancer, n	14	27
Others, n	31	68
Open thoracotomy/TS, n	27/94	33/139	0.51
Procedures, sublobar, n (%)	67 (55.3)	94 (54.7)	0.90
Wedge resection, n	34	51
Segmentectomy, n	33	43
Lobectomy, n	54	78
Histology (AIS + MIA, %), n	24.0	33.7	0.07
AIS + MIA, n	29	58
Invasive adenocarcinoma, n	71	105
Squamous, n	18	7
Others, n	3	2
Pathological stage, more than pIB, n (%)	25 (20.7)	16 (9.3)	<0.01*
0/IA, n	7/89	18/138
IB/IIA/IIB/III/IV, n	15/5/1/3/1	10/2/1/3/0
Any mutations, yes, n (%)	71 (58.7)	112 (65.1)	0.26
EGFR/ALK/KRAS, n	52/17/2	85/22/5
Triple negative, n	50	60

Note:

* P<0.05.

Abbreviations: AIS, adenocarcinoma in situ; CEA, carcinoembryonic antigen; CT, computed tomography; DSG, delayed surgery group; MIA, minimally invasive adenocarcinoma; PET, positron emission tomography; SISG, shorter-interval surgery group; SUV, standardized uptake value; TS, thoracoscopic surgery.

Figure 3 Kaplan–Meier graphs of overall survival in the study population.

Notes: (A) Disease-free survival after the first detection of potential non-small-cell lung cancer opacities in the study population. Black line, the LISG (n=172) and red line, the SISG (n=121). (B) Overall survival at the first detection. Black line, the LISG (n=172) and red line, the SISG (n=121). *P<0.05.

Abbreviations: LISG, longer-interval surgery group; SISG, shorter-interval surgical group.

Table 2 Results of univariate and multivariate analyses for disease-free survival after the first detection of potential NSCLC opacities

	Univariate	Multivariate
	P-value	HR (95% CI)	P-value
Age	0.25
Gender (female)	0.02*	0.49 (0.15–1.59)	0.24
Smoking (pack-year >40)	0.11	0.76 (0.25–2.26)	0.62
History of various cancer (yes)	0.79
Tumor marker
CEA abnormality (>5 ng/mL)	<0.01*	3.11 (1.25–7.73)	0.02*
CT findings
CT consolidation ratio (>0.5)	<0.01*	7.49 (1.47–38.2)	0.02*
Mediastinal diameter (>5 mm)	<0.01*	1.82 (0.68–4.88)	0.24
Tumor size (>10 mm)	0.75
Sublobar resection (yes)	0.37
Mutation status (EGFR/ALK/KRAS)	0.02*	0.30 (0.11–0.83)	0.02*

Note:

* P<0.05.

Abbreviations: CEA, carcinoembryonic antigen; CT, computed tomography; NSCLC, non-small-cell lung cancer.

Figure 4 Kaplan–Meier graphs of overall survival in the SISG.

Notes: (A) Disease-free survival after the first detection of potential NSCLC opacities in all enrolled patients. Black line: the LISG (n=172); blue line: the low-risk SISG (n=81); and red line: the high-risk SISG (n=40). (B) Overall survival at the first detection. Black line: the LISG (n=172); blue line: the low-risk SISG (n=81); and red line: the high-risk SISG (n=40). *Indicates significance (P<0.05).

Abbreviations: CT, computed tomography; LISG, longer-interval surgery group; NSCLC, non-small-cell lung cancer; SISG, shorter-interval surgical group.

Table 3 The relationship among the mutation status and the other prognostic factors

Mutation status
CT consolidation (ratio)	CT consolidation ratio 0–0.5 (n=163)	CT consolidation ratio >0.5 (n=130)	P-value
EGFR	88 (54.0%)	49 (37.7%)	<0.01*
KRAS	18 (11.0%)	21 (16.2%)	0.20
ALK	1 (0.6%)	6 (4.6%)	0.03*
Triple negative	56 (34.4%)	54 (41.5%)	0.21
CEA	CEA within normal limit (£5 ng/mL), (n=257)	CEA abnormality (>0.5 ng/mL), n=36)	P-value
EGFR	126 (49.0%)	11 (30.6%)	0.04*
KRAS	36 (14.0%)	3 (8.3%)	0.35
ALK	6 (2.3%)	1 (2.8%)	0.87
Triple negative	89 (34.6%)	21 (58.3%)	<0.01*

Note:

* P<0.05.

Abbreviations: CEA, carcinoembryonic antigen; CT, computed tomography.