Does a Multi-Location CT Scan Provide a Survival Benefit as Surveillance after Curative-Intent Surgery in Early-Stage Non-Small Cell Lung Cancer?
The NCCN guidelines recommend a chest computed tomography (CT) scan every 6 months for 2-3 years for patients with early-stage non-small cell lung cancer (NSCLC). This study aimed to evaluate whether multi-location CT scans offer a survival benefit.
This study collected clinical data for NSCLC patients who underwent curative intent surgery between 2014 and 2018. Patients were grouped by surveillance CT type: chest CT only (Group CC) or combined chest-abdominal CT (Group CA). The primary outcomes include all-cause mortality, the risk of NSCLC recurrence, and the risk of developing a second primary cancer. Multivariable time-varying Cox models adjusted for clinical factors (age, sex, stage, hospital) and six covariates, including comorbidities, smoking, MVPA, CT frequency, time since surgery, and post-op cancer diagnosis.
Of 32,426 patients, 23,501 were analyzed after exclusions; 22,097 were in Group CC and 1,404 in Group CA. Group CC had a higher recurrence rate (18.7% vs. 14.4%), while Group CA had higher all-cause mortality (19.7% vs. 18.0%). Adjusted Cox analysis showed higher recurrence detection in Group CA (HR 1.80, 95% CI: 1.60-2.01) and lower mortality (HR 0.82, 95% CI: 0.71-0.94) vs. Group CC among patients with recurrence or second cancers. Subgroup analysis showed higher recurrence detection in Group CA for both stages. Mortality was reduced in regional stage (HR 0.77, 95% CI: 0.64-0.93), but not in local stage (HR 1.03, 95% CI: 0.78-1.35).
Multi-location CT surveillance after curative surgery in early-stage NSCLC, especially regional-stage, was associated with lower mortality, recurrence, and second primary cancer risk.
This study collected clinical data for NSCLC patients who underwent curative intent surgery between 2014 and 2018. Patients were grouped by surveillance CT type: chest CT only (Group CC) or combined chest-abdominal CT (Group CA). The primary outcomes include all-cause mortality, the risk of NSCLC recurrence, and the risk of developing a second primary cancer. Multivariable time-varying Cox models adjusted for clinical factors (age, sex, stage, hospital) and six covariates, including comorbidities, smoking, MVPA, CT frequency, time since surgery, and post-op cancer diagnosis.
Of 32,426 patients, 23,501 were analyzed after exclusions; 22,097 were in Group CC and 1,404 in Group CA. Group CC had a higher recurrence rate (18.7% vs. 14.4%), while Group CA had higher all-cause mortality (19.7% vs. 18.0%). Adjusted Cox analysis showed higher recurrence detection in Group CA (HR 1.80, 95% CI: 1.60-2.01) and lower mortality (HR 0.82, 95% CI: 0.71-0.94) vs. Group CC among patients with recurrence or second cancers. Subgroup analysis showed higher recurrence detection in Group CA for both stages. Mortality was reduced in regional stage (HR 0.77, 95% CI: 0.64-0.93), but not in local stage (HR 1.03, 95% CI: 0.78-1.35).
Multi-location CT surveillance after curative surgery in early-stage NSCLC, especially regional-stage, was associated with lower mortality, recurrence, and second primary cancer risk.