Conditional survival analysis of patients with resected non–small cell lung cancerCentral MessagePerspective
Talib Chaudhry, MD,
Vaishnavi Krishnan, MD,
Andrew E. Donaldson, MD,
Zachary M. Palmisano, BS,
Sanjib Basu, PhD,
Nicole M. Geissen, DO,
Justin M. Karush, MD,
Gillian C. Alex, MD,
Jeffrey A. Borgia, PhD,
Michael J. Liptay, MD,
Christopher W. Seder, MD
Affiliations
Talib Chaudhry, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Vaishnavi Krishnan, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Andrew E. Donaldson, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Zachary M. Palmisano, BS
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Sanjib Basu, PhD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Nicole M. Geissen, DO
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Justin M. Karush, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Gillian C. Alex, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Jeffrey A. Borgia, PhD
Department of Pathology, Rush University Medical Center, Chicago, Ill; Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Ill
Michael J. Liptay, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
Christopher W. Seder, MD
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill; Address for reprints: Christopher W. Seder, MD, Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Joan and Paul Rubschlager Building, 6th Floor, 1520 W Harrison St, Chicago, IL 60612.
Background: Conditional survival (CS) analyses provide an estimate of survival accounting for years already survived after treatment. We aim to evaluate the difference between actuarial and conditional survival in patients following lung resection for non–small cell lung cancer (NSCLC). In addition, CS analyses are used to examine whether prognosticators of survival change over time following surgery. Methods: Patients who underwent anatomic lung resection at a single institution for pathologic stage I-IIIA NSCLC between 2010 and 2021 were identified; those who underwent wedge resection for node-negative tumors ≤2 cm were also included. CS estimates were calculated as the probability of remaining disease-free after x years of nonrecurrence (CSx). Kaplan–Meier, log-rank, and Cox proportional hazard methods for examining CS were used for subgroup comparisons and assessing associations with baseline covariates. Results: Overall, 863 patients met the study inclusion criteria, with a median follow-up of 44.1 months. Conditional overall survival (OS) and disease-free survival (DFS) were greater than actuarial rates at all time points after surgery. At the time of resection, male sex (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.03 to 1.72; P = .032), tumor size >3 cm (HR, 1.17; 95% CI, 1.11-1.23; P < .001), node positivity (HR, 3.31; 95% CI, 2.52-4.33; P < .001), and American Joint Committee on Cancer stage (P < .001) were associated with DFS. However, if a patient lived 3 years without recurrence (CS3), these factors were no longer prognostic of DFS. Conclusions: Conditional survival analyses provide dynamic assessments of OS and DFS after NSCLC resection. After 3 years without recurrence, certain characteristics associated with DFS at the time of surgery no longer prognosticate recurrence.
