Evidence map›Paper›PMID 35093293›Full record

ArticleClinical lung cancer2022

Association of Operability With Post-Treatment Mortality in Early-Stage Non-Small Cell Lung Cancer.

William A Stokes, Niya Xiong, Yuan Liu, Kristin A Higgins, Sibo Tian, Jeffrey D Bradley, Drew Moghanaki, Chad G Rusthoven

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical lung cancer, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.2field-weighted citation impact, top 55% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

William A StokesWinship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA. Electronic address: wastoke@emory.edu.
Niya XiongDepartment of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA; Department of Data Science, Dana Farber Cancer Institute (current institutional affiliation), Boston, MA.
Yuan LiuWinship Cancer Institute, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA.
Kristin A HigginsWinship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
Sibo TianWinship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
Jeffrey D BradleyWinship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
Drew MoghanakiDepartment of Radiation Oncology, David Geffen School of Medicine at University of California Los Angeles, CA.
Chad G RusthovenDepartment of Radiation Oncology, University of Colorado School of Medicine, CO.
Emory University · USUniversity of California, Los Angeles · USUniversity of Colorado Denver · US

Funding

Winship Cancer Institute Cancer Center Support GrantP30CA138292 · NCI · EMORY UNIVERSITY · PI Suresh S Ramalingam · 2009 to 2026
$47.5M
NCI NIH HHS P30 CA138292
6 · The paper itself

Abstract

backgroundOperability is both a crucial determinant in treatment selection and a potential confounder in analyses comparing surgery with non-surgical approaches such as stereotactic body radiotherapy (SBRT). We aimed to assess the association between operability status and intervention with post-treatment mortality in early-stage non-small cell lung cancer (NSCLC). PATIENTS AND

methodsWe defined four groups of patients with cT1-T2N0M0 NSCLC diagnosed 2010 to 2014 from the National Cancer Database: SBRT patients deemed operable vs. inoperable and surgery patients receiving open vs. minimally-invasive approaches. Mortality rates at 30, 60, and 90 days post-treatment were calculated and compared.

resultsWe abstracted 80,108 patients, 0.8% undergoing SBRT and operable, 13.2% undergoing SBRT and inoperable, 52.4% undergoing open surgery, and 33.7% undergoing minimally-invasive surgery. Mortality rates were highest among open surgery patients and lowest among operable SBRT patients (2.0% vs. 0.2% at 30 days and 3.7% vs. 0.7% at 90 days), with intermediate results in the other two groups. These findings persisted on multivariate Cox regression: compared to patients undergoing minimally-invasive surgery, mortality risk was highest among open surgery patients (30 days HR 1.32, 95%CI 1.16-1.51; 90 days HR 1.36, 95%CI 1.24-1.50; both P < .001) and lowest among operable SBRT patients (30 days HR 0.09, 95%CI 0.01-0.64; 90 days HR 0.15, 95%CI 0.05-0.46; both P ≤ .016). These associations were maintained in a propensity score-matched subset.

conclusionOperable patients undergoing SBRT experience minimal post-treatment mortality compared to their inoperable counterparts. These findings illustrate the potential for confounding by operability to bias results in cohort studies that compare surgical vs. non-surgical approaches in early-stage NSCLC.

Indexed as

Carcinoma, Non-Small-Cell LungLung NeoplasmsRadiosurgerySmall Cell Lung CarcinomaHumansNeoplasm StagingTreatment OutcomeConfoundingConfounding by indicationConfounding by operabilityEarly-stage non-small cell lung cancerSBRT

Identifiers

PMID35093293
PMCPMC9106833
OpenAlexW4205138637

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.