Association between imaging surveillance frequency and outcomes following surgical treatment of early-stage lung cancer
Menée à partir de données portant sur 6 171 patients atteints d'un cancer du poumon non à petites cellules de stade I traité par chirurgie entre 2006 et 2016, cette étude évalue l'association entre la fréquence des examens de contrôle par tomographie numérique dans les deux ans qui suivent la chirurgie et la survie des patients
Background : Recent studies have suggested that more frequent post-operative surveillance imaging via computed tomography (CT) following lung cancer resection may not improve outcomes. We sought to validate these findings using a uniquely compiled dataset from the Veterans Health Administration, the largest integrated healthcare system in the United States.
Methods : We performed a retrospective cohort study of Veterans with pathologic stage I non-small cell lung cancer (NSCLC) receiving surgery (2006-2016). We assessed the relationship between surveillance frequency (chest CT scans within 2 years after surgery) and recurrence-free survival and overall survival.
Results : Among 6171 patients, 3047 (49.4%) and 3124 (50.6%) underwent low-frequency (<2 scans/year; every 6-12 months) and high-frequency (
≥
2 scans/year; every 3-6 months) surveillance, respectively. Factors associated with high-frequency surveillance included being a former smoker (vs. current, adjusted odds ratio [aOR] 1.18, 95% CI 1.05-1.33), receiving a wedge resection (vs. lobectomy, aOR 1.21, 95% CI 1.05-1.39), and having follow-up with an oncologist (aOR 1.58, 95% CI 1.42-1.77), whereas African American race was associated with low-frequency surveillance (vs. White race, aOR 0.64, 95% CI 0.54-0.75). With a median (IQR) follow-up of 7.3 (3.4-12.5) years, recurrence was detected in 1360 (22.0%) patients. High-frequency surveillance was not associated with longer recurrence-free survival (adjusted hazard ratio [aHR], 0.93; 95% CI, 0.83-1.04, p = 0.22) or overall survival (aHR, 1.04; 95% CI, 0.96-1.12, p = 0.35).
Conclusions : We found that high-frequency surveillance does not improve outcomes in surgically treated stage I NSCLC. Future lung cancer treatment guidelines should consider less frequent surveillance imaging in patients with stage I disease.
Journal of the National Cancer Institute , article en libre accès, 2021