Patient and hospital factors for outcomes of completely resected, node-negative nonsmall cell lung cancer.

Abstract

Objectives: To evaluate outcomes of early-stage nonsmall cell lung cancer (NSCLC) patients in relation to patient and hospital factors.

Summary background data: Results of randomized controlled trials (RCTs) may not be applicable to daily practice.

Methods: Outcomes of patients who had undergone curative surgery for node-negative NSCLC were retrospectively evaluated. They were either participants in an RCT (JCOG0707) or those excluded from it. "Excluded patients" were either ineligible to ("ineligible cohort") or eligible but did not participate ("eligible cohort") in the RCT. Correlations between hospital volume, study forwardness, and patient outcomes were also analyzed.

Results: A total of 5921 patients, 917 in JCOG0707, were evaluated. The overall survival (OS) of the eligible cohort (n = 2616) was similar to the JCOG0707 cohort with an adjusted hazard ratio (aHR) of 1.01 (P = .90), while that of the ineligible cohort (n = 2388) was significantly worse, with an aHR of 1.67 (P < .0001). Both deaths from lung cancer and from other causes led to the inferior outcome. The OS of patients in the ineligible cohort, excluded from the trial due solely to the presence of concomitant malignancy (n = 704), was significantly worse than OS in the eligible cohort, but disease-specific survivals were not significantly different. Hospital volume did not affect OS (high vs low: aHR 0.91, P = .13), but high-volume hospitals had lower "other-cause" mortality (aHR 0.79, P = .02).

Conclusions: RCT-ineligible patients had worse OS, and their excess mortalities are mainly attributed to nonlung-cancer-specific deaths.