Tyler Grenda

M.D., M.S.

Sidney Kimmel Medical College, Thomas Jefferson University

Assistant Professor, Division of Thoracic Surgery, Department of Surgery

NLST (Learn more about this study)

NLST-633

Jan 27, 2020

Comparison of National Lung Cancer Resection Outcomes to Screening Trial Outcomes

Lung cancer screening has been approved by payers (e.g. Medicare, private insurance) after demonstration of mortality benefits in several studies. Benefits are related to detection of early-stage lung cancers (stage I-II) in high-risk patient populations and subsequent surgical resection. Many of these studies were conducted in specialized centers, with experience in lung cancer treatment. However, current practice of lung cancer treatment in the United States is not necessarily reflective of the same conditions as in lung cancer screening trials. Wide variations in risk-adjusted outcomes (e.g. 30-day and 90-day mortality) following lung cancer resection has previously been demonstrated in the literature. Given the wide variation in perioperative outcomes observed in previous studies, current "real world" practice may not realize or demonstrate the mortality benefits demonstrated in previous screening studies. Further evaluation needs to be performed to compare current perioperative outcomes to those observed in lung cancer screening studies, such as the National Lung Screening Trial (NLST).

Since the National Cancer Database (NCDB) captures over 70% of all cancer diagnoses, we aim to compare perioperative outcomes (e.g. 30-day and 90-day mortality) using the National Cancer Database (NCDB) and the NLST datasets to compare "current real world" outcomes to those observed in screening trials. We plan to evaluate risk-adjusted perioperative outcomes by facility for patients undergoing lung cancer resection in each cohort. We will then compare facility-level perioperative outcomes to determine if significant variations in outcomes are observed for surgical resection under performed under screening trials versus a broader national cohort.

Data from this study will inform future studies aimed at understanding factors underlying variations in outcomes for patients undergoing lung cancer resection under screening programs.

Specific Aims:

1. Compare patient and disease factors between NLST dataset and a national dataset (NCDB) of patients undergoing lung cancer treatment
2. Identify variation in facility-level perioperative (e.g.30-day and 90-day mortality) risk-adjusted outcomes following lung cancer resection between NLST dataset and a national dataset (NCDB) reflective of national practice patterns/outcomes