Patient and Facility Demographics Related Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Radiofrequency Ablation: A National Cancer Database Analysis
The role of patient demographics and facility volume play with regards to survival after surgery for NSCLC has been established in multiple prior studies. However, while survival data is available for radiofrequency (RF) ablation of NSCLC, the impact of patient demographics and facility volume is not known in these patients undergoing RF ablation.
The purpose of this investigation was to evaluate the effect that these factors have on OS after RF ablation in early-stage NSCLC using the National Cancer Database (NCDB). The investigators performed a retrospective cohort study of all patients diagnosed with NSCLC from 2004 to 2014. Patients with metastatic and or nodal disease were excluded (T1aN0M0 and T1bN0M0). Additionally, patients who received chemotherapy or radiation at any time were excluded. The final cohort was a total of 967 patients. Patient demographic factors incorporated into the analysis included insurance status, income, education level and residence type. Facility demographic variables evaluated included facility type (community cancer program, comprehensive community cancer program, academic/research program, or integrated network cancer program) and facility volume. Patients were separated into those treated at high-volume centers (HVCs) and those who were not (non-HVC). After propensity score-weighted analysis of a matched cohort of 574 patients, the significant improvement in OS persisted with 1-, 3-, and 5-year OS of 89.4%, 51.2%, and 27.7%, respectively, in the HVC group, compared to 85.2%, 42.0, and 19.6%, respectively, in the non-HVC group (P=.015). Worse OS after RF ablation was significantly associated with increasing age and higher T-classification.
This study suggests there is a significant survival benefit in patients treated with RF ablation for NSCLC in higher volume institutions. What to do with this knowledge remains the question. Additionally, more work will need to be done to look further at the specific variables accounting for this difference, apart from the higher volumes done at these centers. With all things equal, ablative technologies for NSCLC can then be pitted head to head with the current standard of care.
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Lam, Alexander, et al. Patient and Facility Demographics Related Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Radiofrequency Ablation: A National Cancer Database Analysis. Journal of Vascular and Interventional Radiology. November, 2018. Volume 29, Issue 11, 1535–1541.
Zagum Bhatti, MD
Department of Radiology, Interventional Radiology Division
University of Texas Health Science Center at Houston, Houston, TX