Critical timing: Impact of delays to surgery on prognosis in stage I-II non-small cell lung cancer

Abstract

Background Delaying surgery affects the prognosis of patients with lung cancer, but the critical time point at which it becomes detrimental to survival. Identifying this critical time point may benefit patients and guide clinical practice. Methods Data from patients diagnosed with stage I-II non-small cell lung cancer (NSCLC) were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were employed to evaluate prognostic factors associated with overall survival (OS) and to identify time points from diagnosis to surgery that significantly impact prognosis. Kaplan-Meier curves and subgroup analyses were conducted to validate the affect of early versus late surgery on OS. Multinomial logistic regression was utilized to evaluate factors associated with delays in the time from diagnosis to surgery. Results We included 55,582 adult patients with stage I-II NSCLC from the SEER database. Time to surgery (TTS) was identified as an independent prognostic factor for OS in stage I-II NSCLC patients through multivariate Cox regression analysis. Compared to surgeries performed within 6 weeks of TTS, those performed after 6 weeks of TTS (HR: 1.22, 95% CI: 1.20–1.25, P < 0.001) were significantly related to poorer OS. Multinomial logistic regression revealed that age, sex, race, and marital status were risk factors for delayed TTS after diagnosis. Compared to patients with a TTS of 0–40 days, those with a TTS of 63–111 days had the following risks: for patients aged ≥ 75 years, the odds ratio (OR) was 1.46 (95% CI: 1.32–1.62, P < 0.001); for males, the OR was 1.15 (95% CI: 1.09–1.20, P < 0.001). Conclusion Compared to stage I-II NSCLC patients who underwent surgery more than 6 weeks after diagnosis, those who underwent surgery within 6 weeks had significantly higher survival rates. Delays in surgery were associated with adverse social factors.