Survival Differences by Comorbidity Burden among Patients with Stage I/II Non-Small-Cell Lung Cancer after Thoracoscopic Resection

SIMPLE SUMMARY: There is limited research on the relationship between comorbidity burden and survival among patients with stage I/II non-small-cell lung cancer (NSCLC). Thus, the purpose of this study was to compare survival by comorbidity burden among stage I/II NSCLC patients who have received thoracoscopic surgery as their primary treatment. We found that increasing comorbidity burden was associated with a higher risk of all-cause mortality and that the impact of comorbidity on survival was stronger in female patients with NSCLC than in male patients. These findings highlight the importance of considering comorbidities to optimize the selection of candidates for thoracoscopic resection. ABSTRACT: We sought to compare overall survival (OS) by comorbidity burden among patients with stage I/II non-small cell lung cancer (NSCLC) who received thoracoscopic resection. Utilizing data from the National Cancer Database, we conducted a survival analysis among patients aged 50+ with stage I/II NSCLC who received thoracoscopic resection between 2010 and 2017. The comorbidity burden was measured by the Charlson comorbidity index (CCI, 0, 1, 2+). Multivariable Cox proportional hazard models were used to compare overall survival relative to the CCI (CCI of 0 as the referent). Subgroup analyses were conducted considering sex, age groups, days from diagnosis to surgery, facility type, laterality, and type of surgery. For this study, 61,760 patients were included, with a mean age of 69.1 years (SD: 8.5). Notably, 51.2% had a CCI of 0, 31.8% had a CCI of 1, and 17.0% had a CCI of 2+. Most participants were non-Hispanic White (87.5%), and 56.9% were female. We found that an increase in the CCI was associated with a higher risk of all-cause mortality (CCI 1 vs. 0 aHR: 1.24, 95% CI: 1.20–1.28; CCI 2+ vs. 0 aHR: 1.51, 95% CI: 1.45–1.57; p-trend < 0.01). Our subgroup analysis according to sex suggested that the association between CCI and risk of death was stronger in women.