Send to

Choose Destination
J Thorac Oncol. 2017 Dec;12(12):1814-1823. doi: 10.1016/j.jtho.2017.09.1952. Epub 2017 Sep 23.

Improved Survival of Stage I Non-Small Cell Lung Cancer: A VA Central Cancer Registry Analysis.

Author information

Department of Radiation Oncology, Duke University, Durham, North Carolina.
Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Administration Medical Center, Durham, North Carolina; Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.
Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina.
Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina; Division of Hematology-Oncology, Medical Service, Durham Veterans Administration Medical Center, Durham, North Carolina.
Department of Radiation Oncology, Duke University, Durham, North Carolina. Electronic address:



The combined impact of advances in diagnosis and treatment of stage I NSCLC has not been assessed comprehensively. To define the survival impact of modern staging and treatment techniques for clinical stage I NSCLC, the Veterans Administration Central Cancer Registry, a database of U.S. veterans in whom the disease was diagnosed in the Veteran's Health Administration, was queried. From this database, patients who had stage I NSCLC diagnosed from 2001 to 2010 and were treated with either surgery or radiation were identified.


Overall survival (OS) and lung cancer-specific survival were determined. Propensity score matching and Cox multivariate analysis were used to adjust for baseline patient characteristics.


A total of 11,997 patients were identified. The 4-year OS rate increased from 38.9% to 53.2% from 2001 to 2010 for all patients. Positron emission tomography and endobronchial ultrasound did not improve OS. Survival of radiated patients improved from 12.7% to 28.5%. The introduction of stereotactic body radiation therapy (SBRT) significantly improved OS (hazard ratio [HR] = 0.60, 95% confidence interval [CI]: 0.54-0.68) and lung cancer-specific survival (HR = 0.39, 95% CI: 0.32-0.46) compared with conventionally fractionated radiation. The 4-year OS rate also improved after surgery (from 51.5% to 66.5%). This increase was associated with use of adjuvant chemotherapy, increased use of video-assisted thoracoscopic surgical procedures, and decreased pneumonectomy rates, with similar survival between open and video-assisted thoracoscopic surgical procedures. OS after lobectomy was superior to that after sublobar resection (HR = 0.82, 95% CI: 0.75-0.89). In the era of available SBRT (2008-2010), 4-year OS was not significantly different after sublobar resection or lobectomy for medically unfit patients (Charlson comorbidity index = 2) (55.4% and 58.1%, respectively; p = 0.69) but was significantly worse for fit patients (Charlson comorbidity index = 0-1) undergoing sublobar resection (55.5% and 68.0%, respectively; p < 0.001). OS (HR = 0.36, 95% CI: 0.35-0.38) and lung cancer-specific survival (HR = 0.31, 95% CI: 0.29-0.33) were improved after surgery as compared with after radiation, with the improvement maintained on matched comparison of lobectomy and SBRT.


OS increased in veterans with a diagnosis of stage I NSCLC from 2001 to 2010; the increase was coincident with improved radiation and surgical techniques.


Non–small cell lung cancer; SBRT; early stage; radiation; stage I; surgery

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center