Abstract
Background
Lobectomy remains the cornerstone of care for stage I NSCLC while sublobar resection
and stereotactic body radiation therapy (SBRT) are reserved for patients with smaller
tumors and/or poor operative risk. Herein, we investigate the effect of patient frailty
on treatment modality for stage I NSCLC at a safety-net hospital.
Patients and Methods
A retrospective chart review was performed of stage I NSCLC patients between 2006
and 2015. Demographics, patient characteristics, and treatment rates were compared
to a National Cancer Database cohort of stage 1 NSCLC patients. Patient frailty was
assessed using the MSK-FI.
Results
In our cohort of 304 patients, significantly fewer patient were treated via lobectomy
compared to national rates (P < .001). Advanced age (P = .02), lower FEV1 (P < .001) and DLCO (P < .001), not socioeconomic factors, were associated with higher utilization of non-lobectomy
(sublobar resection or SBRT). Patients with lower MSK-FI were more likely to receive
any surgical treatment (P = .01) and lobectomy (P = .03). Lower MSK-FI was an independent predictor for use of lobectomy over other
modalities (OR 0.75, P = .04). MSK-FI (OR 0.64, P = .02), and FEV1 (OR 1.03, P < .001) were independently associated with use of SBRT over any surgery.
Conclusion
Our safety-net hospital performed fewer lobectomies and lung resections compared to
national rates. Patient frailty and clinical factors were associated with use of SBRT
or sublobar resection suggesting that the increased illness burden of a safety-net
population may drive the lower use of lobectomy. The MSK-FI may help physicians stratify
patient risk to guide stage I NSCLC management.
Keywords
Abbreviations:
NSCLC (Non-small cell lung cancer), MSK-FI (Memorial Sloan Kettering frailty index), SBRT (Stereotactic body radiation therapy), FEV1 (Forced Expiratory Volume in 1 second), DLCO (Diffusion lung capacity for carbon monoxide)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 27, 2022
Accepted:
December 20,
2022
Received in revised form:
October 20,
2022
Received:
May 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
