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.