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More Frequent Surveillance Following Lung Cancer Resection Is Not Associated With Improved Survival

A Nationally Representative Cohort Study

McMurry, Timothy L., PhD*; Stukenborg, George J., PhD*; Kessler, Larry G., ScD; Colditz, Graham A., MD, DrPH; Wong, Melisa L., MD, MS§; Francescatti, Amanda B., MS; Jones, David R., MD||; Schumacher, Jessica R., PhD**; Greenberg, Caprice C., MD, MPH**; Chang, George J., MD, MS††; Winchester, David P., MD; McKellar, Daniel P., MD; Kozower, Benjamin D., MD, MPH

doi: 10.1097/SLA.0000000000002955

Objective: To evaluate whether an association exists between the intensity of surveillance following surgical resection for non–small cell lung cancer (NSCLC) and survival.

Background: Surveillance guidelines following surgical resection of NSCLC vary widely and are based on expert opinion and limited evidence.

Methods: A Special Study of the National Cancer Database randomly selected stage I to III NSCLC patients for data reabstraction. For patients diagnosed between 2006 and 2007 and followed for 5 years through 2012, registrars documented all postsurgical imaging with indication (routine surveillance, new symptoms), recurrence, new primary cancers, and survival, with 5-year follow-up. Patients were placed into surveillance groups according to existing guidelines (3-month, 6-month, annual). Overall survival and survival after recurrence were analyzed using Cox Proportional Hazards Models.

Results: A total of 4463 patients were surveilled with computed tomography scans; these patients were grouped based on time from surgery to first surveillance. Groups were similar with respect to age, sex, comorbidities, surgical procedure, and histology. Higher-stage patients received more surveillance. More frequent surveillance was not associated with longer risk-adjusted overall survival [hazard ratio for 6-month: 1.16 (0.99, 1.36) and annual: 1.06 (0.86–1.31) vs 3-month; P value 0.14]. More frequent imaging was also not associated with postrecurrence survival [hazard ratio: 1.02/month since imaging (0.99–1.04); P value 0.43].

Conclusions: These nationally representative data provide evidence that more frequent postsurgical surveillance is not associated with improved survival. As the number of lung cancer survivors increases over the next decade, surveillance is an increasingly important major health care concern and expenditure.

*Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA

Department of Health Services, School of Public Health, University of Washington, Seattle, WA

Divisions of Cardiothoracic Surgery and Public Health Sciences, Washington University School of Medicine, St. Louis, MO

§Divisions of Hematology/Oncology, University of California San Francisco, San Francisco, CA

Commission on Cancer and Cancer Programs, American College of Surgeons, Chicago, IL

||Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY

**Department of Surgery, University of Wisconsin, Madison, WI

††Department of Surgical Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.

Reprints: Benjamin D. Kozower, MD, MPH, Division of Cardiothoracic Surgery, Washington University School of Medicine. One Barnes-Jewish Hospital Plaza, Suite 3108 Queeny Tower, St. Louis, MO 63110-1013. E-mail:

This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CE-1306-00727, PI Kozower), the National Cancer Institute (UG1CA189823, Alliance for Clinical Trials in Oncology NCORP Research Base), and the Biostatistics Shared Resource, Siteman Cancer Center (CA091842).

The content is solely the responsibility of the authors and does not necessarily represent the official views of PCORI, the National Institutes of Health, the National Institute on Aging, or the National Cancer Institute.

Accepted for presentation at the American Surgical Association Meeting in Phoenix, April 19 to 21, 2018.

The authors report no conflicts of interest.

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