Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival
Introduction: Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364323000905 |
| _version_ | 1827860763399684096 |
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| author | Jorge Humberto Rodriguez-Quintero, MD Mohamed K. Kamel, MD Gbalekan Dawodu, MD Mostafa Elbahrawy, MD, PhD Marc Vimolratana, MD Neel P. Chudgar, MD Brendon M. Stiles, MD |
| author_facet | Jorge Humberto Rodriguez-Quintero, MD Mohamed K. Kamel, MD Gbalekan Dawodu, MD Mostafa Elbahrawy, MD, PhD Marc Vimolratana, MD Neel P. Chudgar, MD Brendon M. Stiles, MD |
| author_sort | Jorge Humberto Rodriguez-Quintero, MD |
| collection | DOAJ |
| description | Introduction: Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly apparent in patients undergoing pneumonectomy, in whom the physiologic insult and surgical complications may preclude adjuvant therapy (ADJ). We, therefore, evaluated the use of ST for patients with NSCLC undergoing pneumonectomy. Methods: We queried the National Cancer Database, including all patients with NSCLC who underwent pneumonectomy between 2006 and 2018. Logistic regression was used to identify associations with ST and neo-ADJ (NEO). Overall survival was compared after propensity score matching (1:1) patients undergoing ST to those undergoing surgery alone using Kaplan-Meier and Cox regression methods. Results: A total of 2619 patients were identified. Among these, 12% received NEO, 43% received ADJ, and 45% surgery alone. Age younger than 65 years (adjusted odds ratio [aOR] = 1.53, 95% confidence interval; [CI]: 1.10–2.11), Asian ethnicity (aOR = 2.68, 95% CI: 1.37–5.23), treatment at a high-volume center (aOR = 1.39, 95% CI: 1.06–1.81), and private insurance (aOR = 1.42, 95% CI: 1.05–1.94) were associated with NEO, whereas age younger than 65 years (aOR = 1.95, 95% CI: 1.61–2.38), comorbidity index less than or equal to 1 (aOR = 1.66, 95% CI: 1.29–2.16), and private insurance (aOR = 1.47, 95% CI: 1.20–1.80) were associated with any ST. In the matched cohort, ST was associated with better survival than surgery (adjusted hazard ratio = 0.67, 95% CI: 0.58–0.78). Conclusions: A high proportion of patients who undergo pneumonectomy do not receive ST. Patient and socioeconomic factors are associated with the receipt of ST. Given its survival benefit, emphasis should be placed on multimodal treatment strategies, perhaps with greater consideration given to neoadjuvant approaches. |
| first_indexed | 2024-03-12T13:27:31Z |
| format | Article |
| id | doaj.art-7adf76e4596a406e815247ec02e7421e |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-03-12T13:27:31Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-7adf76e4596a406e815247ec02e7421e2023-08-25T04:24:48ZengElsevierJTO Clinical and Research Reports2666-36432023-08-0148100547Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for SurvivalJorge Humberto Rodriguez-Quintero, MD0Mohamed K. Kamel, MD1Gbalekan Dawodu, MD2Mostafa Elbahrawy, MD, PhD3Marc Vimolratana, MD4Neel P. Chudgar, MD5Brendon M. Stiles, MD6Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Corresponding author. Address for correspondence: Brendon M. Stiles, MD, Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge. Bronx, New York.Introduction: Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly apparent in patients undergoing pneumonectomy, in whom the physiologic insult and surgical complications may preclude adjuvant therapy (ADJ). We, therefore, evaluated the use of ST for patients with NSCLC undergoing pneumonectomy. Methods: We queried the National Cancer Database, including all patients with NSCLC who underwent pneumonectomy between 2006 and 2018. Logistic regression was used to identify associations with ST and neo-ADJ (NEO). Overall survival was compared after propensity score matching (1:1) patients undergoing ST to those undergoing surgery alone using Kaplan-Meier and Cox regression methods. Results: A total of 2619 patients were identified. Among these, 12% received NEO, 43% received ADJ, and 45% surgery alone. Age younger than 65 years (adjusted odds ratio [aOR] = 1.53, 95% confidence interval; [CI]: 1.10–2.11), Asian ethnicity (aOR = 2.68, 95% CI: 1.37–5.23), treatment at a high-volume center (aOR = 1.39, 95% CI: 1.06–1.81), and private insurance (aOR = 1.42, 95% CI: 1.05–1.94) were associated with NEO, whereas age younger than 65 years (aOR = 1.95, 95% CI: 1.61–2.38), comorbidity index less than or equal to 1 (aOR = 1.66, 95% CI: 1.29–2.16), and private insurance (aOR = 1.47, 95% CI: 1.20–1.80) were associated with any ST. In the matched cohort, ST was associated with better survival than surgery (adjusted hazard ratio = 0.67, 95% CI: 0.58–0.78). Conclusions: A high proportion of patients who undergo pneumonectomy do not receive ST. Patient and socioeconomic factors are associated with the receipt of ST. Given its survival benefit, emphasis should be placed on multimodal treatment strategies, perhaps with greater consideration given to neoadjuvant approaches.http://www.sciencedirect.com/science/article/pii/S2666364323000905Non–small cell lung cancerSystemic therapyNeoadjuvant therapyPneumonectomyLocally advanced tumor |
| spellingShingle | Jorge Humberto Rodriguez-Quintero, MD Mohamed K. Kamel, MD Gbalekan Dawodu, MD Mostafa Elbahrawy, MD, PhD Marc Vimolratana, MD Neel P. Chudgar, MD Brendon M. Stiles, MD Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival JTO Clinical and Research Reports Non–small cell lung cancer Systemic therapy Neoadjuvant therapy Pneumonectomy Locally advanced tumor |
| title | Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival |
| title_full | Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival |
| title_fullStr | Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival |
| title_full_unstemmed | Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival |
| title_short | Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival |
| title_sort | underutilization of systemic therapy in patients with nsclc undergoing pneumonectomy a missed opportunity for survival |
| topic | Non–small cell lung cancer Systemic therapy Neoadjuvant therapy Pneumonectomy Locally advanced tumor |
| url | http://www.sciencedirect.com/science/article/pii/S2666364323000905 |
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