Initial treatment and survival outcomes for early-stage NSCLC in Veterans: Insights from cancer cube data.

Abstract

8047 Background: Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases and remains the leading cause of cancer-related deaths in the United States. Early-stage NSCLC (Stage I) is potentially curable, with surgical resection as the standard of care. However, for patients who are medically inoperable or decline surgery, stereotactic ablative radiotherapy (SABR) is an alternative. Prior studies suggest that demographic factors, including age, race, and sex, may influence treatment decisions and outcomes, particularly among veterans with a high burden of comorbidities. This study examines treatment patterns and survival outcomes for veterans with Stage I NSCLC using data from the Veterans Affairs Cancer Care Cube. Methods: This retrospective study included veterans diagnosed with Stage I NSCLC between 2000 and 2023. Patients were categorized by initial treatment (surgery or radiation therapy) and stratified by demographics (age, race/ethnicity, gender, and ECOG status). Survival outcomes were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models to control for confounding variables. Logistic regression identified predictors of treatment choice. Patients with incomplete data or advanced-stage disease were excluded. Statistical analyses were conducted using R and Python. Results: Surgery demonstrated superior survival outcomes across all demographics. • Age: Surgery offered significantly higher 5-year survival rates in younger (40–59 years, 41.77–54.32%) and older (>70 years, 42.32%) patients compared to radiation (0–24.68%). • Race: Surgery utilization was consistent across racial groups, with the highest 5-year survival in Asian patients (60.87%). Native Hawaiian/Pacific Islander (NHPI) patients had the lowest survival for both treatments, highlighting disparities in care. • Sex: Women were more likely to undergo surgery (71.79%) and had better survival outcomes than men, similar to trends seen in non-veteran populations. • ECOG Status: Surgery remained the preferred treatment across all ECOG scores, though long-term survival declined with higher ECOG scores. • Exposure Type: Agent Orange and asbestos exposure were associated with the best survival outcomes following surgery, while radiation offered limited long-term benefits regardless of exposure. Conclusions: Surgery consistently yields better survival outcomes than radiation therapy for veterans with early-stage NSCLC, even among subgroups with higher comorbidity burdens. Demographic and exposure-related disparities highlight the need for tailored interventions to optimize care. These findings inform clinical decision-making and emphasize the importance of equitable access to curative treatments in this vulnerable population.