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