Association Between Surgical Quality and Long-Term Survival in Lung Cancer
Menée aux Etats-Unis à partir de données 2014-2016 portant sur 85 396 patients atteints d'un cancer du poumon traité par chirurgie, cette étude analyse l'association entre la qualité du traitement chirurgical mesurée à l'aide d'un indicateur (taux de mortalité à 90 jours) et la survie à 5 ans
Résumé en anglais
Objectives: There are significant variations in both perioperative and long-term outcomes after lung cancer resection. While perioperative outcomes are often used as comparative measures of quality, they are unreliable, and their association with long-term outcomes remain unclear. In this context, we evaluated whether historical perioperative mortality after lung cancer resection is associated with 5-year survival.
Patients and Methods: The National Cancer Database (NCDB) was queried to identify patients diagnosed with non-small cell lung cancer (NSCLC) in 2010-2016 who underwent surgical resection (n=234200). Hospital-level reliability-adjusted 90-day mortality rate quartiles for 2010-2013 was used as the independent variable to analyze 5-year survival for patients diagnosed in 2014-2016 (n=85396).
Results: There were 85,396 patients in the 2014-2016 cohort across 1,086 hospitals. Overall observed 90-day mortality rate was 3.2% (SD 17.6%) with 2.6% (SD 16.0%) for the historically best performing quartile vs. 3.9% (SD 19.4%) for the worst performing quartile (p<0.0001). Patients who underwent resection at hospitals with the best historical mortality rate had significantly better 5-year survival across all stages compared to those treated at hospitals in the worst performing quartile in multivariate Cox regression analysis (all stages – HR 1.21 [95% CI 1.15-1.26]; stage I – HR 1.19 [95% CI 1.12-1.25]; stage II – HR 1.20 [95% CI 1.09-1.32]; stage III – HR 1.36 [95% CI 1.20-1.54]) and Kaplan-Meier survival estimates (all stages – p<0.0001, stage I – p<0.0001; stage II – p=0.0004; stage III – p<0.0001).
Conclusion: With expanded lung cancer screening criteria and likely increase in early-stage detection, profiling performance is paramount to ensuring mortality benefits. We found that episodes surrounding surgical resection may be used to profile long-term outcomes that likely reflect quality across a broader context of care. Evaluating lung cancer care quality using perioperative outcomes may be useful in profiling provider performance and guiding value-based payment policies.
