Abstract 113P
Background
Surgery serves a key role in curative therapy for early-stage non-small cell lung cancer (NSCLC), and operative decision-making is heavily dictated by clinical stage. Multiple patient- and disease-specific factors can influence stage assignment in the therapy-naïve patient. As such, discordant clinical and pathological staging may occur, and clinical overstaging may indicate risk of worse outcomes for patients with features that are not otherwise captured in our staging paradigm. Thus, we sought to evaluate the impact of clinical overstaging on overall survival (OS) in patients with pathologic stage I NSCLC who underwent upfront surgery.
Methods
A single-center database was queried for patients who underwent resection of pathologic stage I NSCLC 1998–2021 in the absence of neoadjuvant therapy. Clinicopathologic, circulomic, and operative details were collected. Patients were grouped by clinical-to-pathologic stage concordance to evaluate impact of clinical overstaging on outcomes. Kaplan-Meier and multivariable analyses were performed to assess impact on OS.
Results
2318 patients met inclusion criteria, among whom 151 (6.5%) were clinically overstaged. Slightly over half were women (1355, 58.4%), most were smokers (1649, 71.0%), and median age was 67.0 years (interquartile range [IQR]: 60.1–73.3). In clinically overstaged patients, clinical tumor (T) and nodal (N) statuses were significantly discordant from pathologic T and N status (p < 0.001 for both). Moreover, clinically overstaged patients had shorter median OS (115.4 months) than those with stage-concordance (156.7 months, p < 0.001). After controlling for confounders, we found that clinically overstaged patients experienced greater mortality (hazard ratio 1.34, CI 1.04–1.73).
Conclusions
Clinical overstaging of patients with pathologic stage I NSCLC was associated with worse survival compared concordant staging. This finding may be attributable nto patient and disease factors that prompted assignment of higher clinical stage, and further investigation is needed to better elucidate and ameliorate such factors. Moreover, heightened postoperative cancer surveillance may be indicated for patients found to be clinically overstaged.
Legal entity responsible for the study
The authors.
Funding
Mason Family Philanthropic Research Fund.
Disclosure
All authors have declared no conflicts of interest.