Patients with stage I non-small cell lung cancer (NSCLC) should undergo expedited surgical intervention to reduce recurrence risk. These findings were published in JAMA Network Open.

Due to imprecise definitions to determine the appropriate date of NSCLC diagnoses, whether patients are receiving timely or delayed treatment remains unclear. A delay in surgical interventions among patients with early-stage NSCLC has been associated with poorer outcomes.

Data from the Veterans Health Administration (VHA) system from 2006 to 2016 were retrospectively assessed for the time between preoperative diagnostic imaging and surgical treatment for stage I NSCLC and associated with outcomes.

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Patients (N=9904) were aged mean 67.71±7.93 years, 96.31% were men, 83.82% were White, 50.49% were current smokers, and 70.10% underwent lobectomy.

Tumor characteristics were average size, 27.32±10.64 mm; 52.88% were adenocarcinomas; and 1.47% were grade 4, 32.99% grade 3, 52.49% grade 2, and 13.05% grade 1.

The median wait time between diagnostic imaging and surgical intervention was 62 days (interquartile range [IQR], 40-92). A total of 26.6% patients had a 0-day official time from diagnosis to surgery, indicating diagnosis was made during the procedure.

Delayed surgical procedures associated with endobronchial ultrasound or mediastinoscopy (odds ratio [OR], 1.385; 95% CI, 1.226-1.564; P <.001), Black ethnicity (OR vs White race, 1.267; 95% CI, 1.112-1.444; P <.001), and tumor size of 21 to 30 mm (OR, 1.212; 95% CI, 1.003-1.465; P =.004).

Recurrence occurred among 42.0% at a median time of 1.24 years. The risk for recurrence increased by 0.4% (hazard ratio [HR], 1.004; 95% CI, 1.001-1.006; P =.002) for every 12-week delay in surgical intervention.

This study may have been biased by basing delay on the date of diagnostic imaging.

These data indicated a delay of surgical intervention beyond 12 weeks increased risk for recurrence of stage I NSCLC.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Heiden B T, Eaton D B, Engelhardt K E, et al. Analysis of delayed surgical treatment and oncologic outcomes in clinical stage I non–small cell lung cancer. JAMA Netw Open. 2021;4(5):e2111613. doi:10.1001/jamanetworkopen.2021.11613.