Intensity of radical resection for lung cancer in relation to survival outcomes in England


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Henrik Mller1, Ruth Jack1, Karen Linklater1, Victoria Coupland1, Elizabeth Davies1, Mick Peake2

1King's College London, Thames Cancer Registry, London, UK, 2National Cancer Intelligence Network, London, UK

Abstract

Proffered paper presentation

Background
Radical surgery is attempted in a minority of lung cancer patients and these selected patients have a good chance of long term survival. Increasing the resected proportion could possibly increase lung cancer survival in England. This presentation explores survival in relation to the intensity of radical surgical treatment for lung cancer.

Method
We identified 151,965 lung cancer patients (excluding small cell cancers) from cancer registries in England, 1998-2003. Patients with radical surgical treatment were identified from the hospital episode statistics data. We computed the intensity of radical resection in lung cancer patients in PCT populations in England and assigned a PCT quintile of surgery to each patient. The survival of different groups of lung cancer patients were assessed in relation to PCT-quintile-of-surgery, age, sex, socio-economic deprivation, and government office region, using Cox regression analysis.

Results
Intensity of radical resection ranged from 4% to 11% from the lowest to the highest PCT-quintile. Survival in the total patient population increased with radical surgery: upper vs. lower PCT-quintile: HR=0.92; p-trend<0.0001. Among the subset of resected patients, the association was in the opposite direction (p-trend=0.09).

Conclusion
The data suggest that an increase in the intensity of radical surgery could plausibly lead to an overall increase in lung cancer survival. The variation between regions in the UK suggests that other determinants exist (such as the availability of PET scanning) which influence the relationship between surgery and survival.