The negative impact of prolonged staging-to-resection interval on upstaging status in patients with lung adenocarcinoma.

Abstract

Lung cancer screening implementation is increasing globally. Understanding the impact of prolonged staging-to-resection will promote the development of streamlined treatment processes. Single-institution retrospective analysis of 328 patients who had undergone lung resection for early stage lung carcinoma. Clinical staging was performed utilizing computed tomography of the chest, fluorodeoxyglucose positron emission tomography, and tissue biopsy according to the eighth TNM classification. Upstaging status was confirmed by postoperative histopathologic examination of operative specimens. The staging-to-resection intervals were categorized into ≤60 days and >60 days. The proportion of patients with adenocarcinoma, squamous cell carcinoma, and other carcinomas was 208 (63.4%), 72 (22.0%), and 48 (14.6%), respectively. One hundred forty-four (43.9%) patients were upstaged in the study cohort. The median staging-to-resection interval was 41.5 days (28-62), and 90 patients (27.4%) waited >60 days. Of the 208 patients with adenocarcinoma, 59 patients waited >60 days. Of these patients, 50 had preoperative stage I disease. Eighty-eight (42.3%) adenocarcinoma patients were upstaged, including 74 patients with stage I disease. Compared with adenocarcinoma patients undergoing surgery within 60 days, those waiting >60 days had a higher rate of upstaging (38% vs 56%, respectively; P = .012). The difference was also observed in the stage I adenocarcinoma subgroup (37% vs 58%; P = .011). Delays in surgical intervention are associated with increased upstaging rates in lung adenocarcinoma, predominantly at an early stage, highlighting the need for prompt surgery. Lung cancer screening and the anticipated surge in surgical cases necessitate robust strategies to minimize delays and ensure optimal outcomes.