Thoracic: Lung Cancer
The influence of adjuvant therapy on survival in patients with indeterminate margins following surgery for non–small cell lung cancer

Read at the 45th Annual Meeting of the Western Thoracic Surgical Association, Olympic Valley, California, June 26-29, 2019.
https://doi.org/10.1016/j.jtcvs.2019.09.075Get rights and content
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Abstract

Background

The significance of indeterminate margins following surgery for non–small cell lung cancer (NSCLC) is unknown. We evaluated the influence of adjuvant therapy on survival in patients whose cancer showed indeterminate margins.

Methods

Patients whose cancer showed indeterminate margins following surgery for NSCLC were identified in the National Cancer Database between 2004 and 2015, and stratified by receipt of adjuvant treatment. The primary outcome was overall survival, which was evaluated with multivariable Cox proportional hazards.

Results

Indeterminate margins occurred in 0.31% of 232,986 patients undergoing surgery for NSCLC and was associated with worse survival compared with margin negative resection (adjusted hazard ratio, 1.53; 95% confidence interval, 1.40-1.67). Anatomic resection was protective against the finding of indeterminate margins in logistic regression. Amongst 553 patients with indeterminate margins, 343 (62%) received no adjuvant therapy, 96 (17%) received adjuvant chemotherapy, 33 (6%) received adjuvant radiation, and 81 (15%) received adjuvant chemoradiation. Any mode of adjuvant therapy was not associated with improved survival compared with no further treatment.

Conclusions

The finding of indeterminate margins is reported in 0.31% of patients undergoing curative-intent surgery for NSCLC. This was associated with worse overall survival compared with complete resection and not mitigated by adjuvant therapy. The risks and benefits of adjuvant therapy should be carefully considered for patients with indeterminate margins after surgery for NSCLC.

Key Words

lung cancer
non–small cell lung cancer
surgery
margins

Abbreviations and Acronyms

NCDB
National Cancer Database
NSCLC
non–small cell lung cancer
R0
margin negative
R+
margin positive, not otherwise specified
R1
microscopically margin positive
R2
macroscopically margin positive
RID
margin indeterminate for positivity

Cited by (0)

Drs Raman and Voigt were supported by a National Institutes of Health T-32 grant in surgical oncology (No. 5T32CA093245). Dr Jawitz was supported by a National Institutes of Health T-32 grant in clinical research (No. 5T32HL069749).