Commission on Cancer lung cancer surgery quality metric and overall survival in a population-based cohort.

Abstract

8067 Background: The American College of Surgeons Commission on Cancer (CoC) quality metric for curative-intent lung cancer surgery, Operative Standard 5.8 (OS 5.8), requires lymph node sampling from ≥3 mediastinal and ≥1 hilar (“3+1”) stations. We assessed association between adherence to this standard and overall survival in a population-based lung cancer resection cohort. Methods: We evaluated the Mid-South Quality of Surgical Resection cohort, which includes data from all 14 hospitals performing ≥5 annual lung cancer resections across five Hospital Referral Regions in MS, AR, and TN. We compared clinical stage I-III curative-intent resections from 2009 to 2020, examining demographics, tumor characteristics, and outcomes between CoC OS 5.8-concordant and non-concordant groups using chi-squared tests. We calculated adjusted odds ratios (aORs) to quantify concordance association with binary outcomes using logistic regression and adjusted hazard ratios (aHRs) for overall survival with proportional hazards models, adjusting all models for age, race, sex, Charlson comorbidity index, insurance, rurality, institutional volume, smoking status, clinical stage, histology, surgical technique, extent of resection, margin status, and neoadjuvant therapy. Results: Of 5,536 patients, 1,859 (41%) were concordant and 2,677 (59%) were non-concordant. Concordant cases included more White patients (80% v 76%, p<0.0001), metropolitan residents (61% v 47%, p<0.0001), clinical stage II/III cases (25% v 22%, p=0.0055), and anatomic resections (99% v 87%, p<0.0001). Surgical complications were more common in concordant cases (48% v 42%, p=0.0001). After adjustment for key variables, concordance with OS 5.8 was associated with more frequent nodal upstaging (aOR 1.34, 95% CI: 1.11–1.60), adjuvant chemotherapy use (aOR 1.58, 95% CI: 1.33–1.88), and more complications (aOR 1.21, 95% CI: 1.06–1.38). Patients with OS 5.8 concordant resections had significantly lower hazard of death (aHR 0.85, 95% CI: 0.77–0.93, Table). Conclusions: Adherence to CoC OS 5.8 lymph node sampling standards for lung cancer resections was associated with greater nodal upstaging, adjuvant therapy use, and likelihood of postoperative morbidity. Overall survival was significantly better among OS 5.8-concordant cases, supporting the use of this quality metric for curative-intent lung cancer surgery. Oncologic characteristics and outcomes in CoC OS 5.8-concordant v non-concordant resections. Concordantn=1859 Non-concordantn=2677 P-value Clinical stage I 74% 78% 0.0055 Clinical stage II 17% 14% Clinical stage III 8% 8% Nodal upstaging 16% 14% 0.0209 Adjuvant therapy 22% 14% <0.0001 Median overall survival, years (95% CI) 7.8 (7.1-8.6) 6.2 (5.7-6.7) 0.0001 5-year overall survival (95% CI) 60% (58-62) 55% (53-57) 0.0001 aHR (95% CI) 0.85 (0.77-0.93) Ref 0.0004