Objective:

To assess the association between diagnosis-to-surgery interval and long-term survival among patients with stage I NSCLC undergoing anatomic resection.

Approach:

• Design and data: Retrospective cohort study using National Cancer Database data from 2004 through 2023.
• Participants: Included 157,894 adults with stage I adenocarcinoma or squamous cell carcinoma treated with lobectomy or segmentectomy; patients receiving neoadjuvant or adjuvant therapy, with stage II–IV disease, time to treatment over 120 days, or unavailable survival data …
• Analysis: Propensity score matching, Kaplan-Meier methods, and multivariable Cox regression were used to evaluate five-year overall survival and associations with time to treatment.

Key Findings:

• Median time to surgery increased from 23 days in 2004 to 43 days in 2022; same-day surgery decreased from 30.6% to 16.7%.
• Adjusted mortality was lowest when surgery occurred 2 to 4 weeks after diagnosis; the hazard increased subsequently and rose significantly after 8 weeks.
• Five-year overall survival was 74.1% for surgery within 4 weeks and 69.9% for surgery after 4 weeks (log-rank P < .001).
• Surgery after 4 weeks was associated with Black race, Medicaid coverage, lack of insurance, and care involving multiple facilities.

Interpretation:

The authors report that, in this cohort, surgery within 4 weeks was associated with higher five-year overall survival than later surgery. They note that the lower mortality observed during weeks 2 to 4 than in week 1 should not be interpreted as support for delaying surgery.

Limitations:

• Retrospective registry analysis may be affected by unmeasured confounding.
• The database lacked information on reasons for delay, tumor growth kinetics, and radiographic progression.
• Patient complexity or care coordination differences may partly explain observed associations.

Conclusion:

The authors conclude that timely surgical resection, defined as within 4 weeks of diagnosis, should remain a priority in managing early-stage NSCLC.