Long-term Survival After Lung Cancer Resection in the National Lung Screening Trial

BACKGROUND:To evaluate the long-term survival of and causes of death after surgery among patients with pathologic stage IA non-small-cell lung cancer (NSCLC) in the National Lung Screening Trial (NLST). METHODS:Patients who underwent surgery and were diagnosed with pathologic stage IA NSCLC in the NLST were identified for analysis. The primary analyses were conducted among patients undergoing lobectomy. The 5- and 10-year overall survival and lung cancer-specific survival rates, the causes of death, and the cumulative incidence of lung cancer death were evaluated. RESULTS:A total of 380 patients (n=329, 86.6% lobectomy, n=20, 5.3% segmentectomy, n=31, 8.2% wedge resection) met inclusion criteria. Median follow-up time from the date of surgery was 7.8 (IQR: 4.8, 10.7) years. The 10-year overall survival rate was 58.3% (95% CI: 52.4-63.8) for lobectomy, 59.9% (95% CI: 33.2-78.8) for segmentectomy, and 45.2% (95% CI: 20.8-66.9) for wedge resection. The 10-year lung cancer-specific survival rate was 74.3% (95% CI: 68.6-79.1) for lobectomy, 81.3% (95% CI: 51.3-93.8) for segmentectomy, and 84.8% (95% CI: 64.0-94.1) for wedge resection. Lung cancer was the leading cause of death, accounting for 55.8% of deaths after lobectomy. The 10-year cumulative incidence of lung cancer death after lobectomy was 22.5% (95% CI:18.3% to 27.1%). CONCLUSIONS:Ten-year overall survival after lobectomy among patients with pathologic stage IA NSCLC in the NLST was 58%. Lung cancer was the leading cause of death, accounting for over 55% of deaths.