Impact of Nodule Density in Women With Sublobar Resection for Stage IA Adenocarcinoma.

BACKGROUND: This study sought to examine the impact of nodule density on recurrence and survival in female patients with lung adenocarcinoma treated by lobectomy or sublobar resection. METHODS: In this retrospective study of female patients who underwent surgical resection for pathologic stage IA adenocarcinoma, patients with preoperative imaging were included for analysis if the consolidation-to-tumor ratio was 0.5 (solid-predominant ground-glass opacity [GGO]) to 1.0 (solid). Kaplan-Meier curves were generated to estimate overall survival (OS) and disease-free survival (DFS). Risk estimates were calculated using multivariable Cox proportional hazards models. RESULTS: For all 357 patients sublobar resection demonstrated worse 5-year DFS compared with lobectomy (76.4% vs 67.9%, P = .05). Multivariable modeling showed worse DFS with sublobar resection (hazard ratio, 1.55; P = .06) and tumors ≥ 2 cm (hazard ratio, 2.32; P = .05). On radiologic evaluation the solid-predominant GGO group (n = 81) demonstrated a smaller solid component compared with the solid nodule group (n = 163; 1.49 cm vs. 1.84 cm, respectively; P < .001) yet comparable total size. The solid-predominant GGO group showed improved 5-year OS (90.8 vs 76.8, P = .01) and DFS (79.3 vs 67.2, P = .05) compared with the solid nodule group. Additionally the solid-predominant GGO group demonstrated equivalent OS (90.8% vs 90.8%, P = .93) and DFS (76.0% vs 81.7%, P = .60) with sublobar resection compared with lobectomy. CONCLUSIONS: In this report of female patients with stage IA adenocarcinoma, sublobar resection was associated with worse DFS compared with lobectomy in whole-group analysis. However patients with solid-predominant GGOs demonstrated improved 5-year OS and DFS compared with patients with solid nodules with equivalent outcomes regardless of resection type.

Lung Cancer Strategist Program: A novel care delivery model to improve timeliness of diagnosis and treatment in high-risk patients.

INTRODUCTION: The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to care disparities for vulnerable patients. METHODS: A multi-institutional, multidisciplinary conference was convened to address the complexity of lung cancer care particularly in patients at high-risk for treatment delay. The resulting care delivery model, called the Lung Cancer Strategist Program (LCSP), was led by a thoracic-trained advanced practice provider (APP) with emphasis on expedited surgery and early oncologic consultation in the assessment of a newly diagnosed suspicious lung nodule. We performed a retrospective review to evaluate care efficiency and oncologic outcomes in the first 100 LCSP patients compared to 100 concurrent patients managed via routine surgical referral. RESULTS: In the 78 LCSP and 41 routine referral patients managed via nodule surveillance, LCSP patients had a shorter time from suspicious finding to work-up (3 vs. 26 days, p < 0.001) and to surveillance decision (12.5 vs. 39 days, p < 0.001). In the 22 LCSP and 59 routine referral patients treated for intrathoracic malignancy, LCSP patients had fewer hospital visits (4 vs 6, p < 0.001), clinicians seen (1.5 vs. 2, p = 0.08), and diagnostic studies (4 vs 5, p = 0.01) with a shorter time to diagnosis (30.5 vs. 48 days, p = 0.02) and treatment (40.5 vs. 68.5 days, p = 0.02). CONCLUSIONS: Patient triage through a thoracic-trained APP in consultation with surgical, medical, and radiation oncology facilitates rapid assessment of benign versus malignant lesions with reduced time to diagnosis and treatment, even among patients at high-risk for treatment delay.