Treatment at academic centers yields survival benefit in metastatic NSCLC
Patients with metastatic non-small cell lung cancer who received treatment at academic centers demonstrated significantly better 2-year survival rates than patients who were treated at community centers, according to results of a retrospective analysis.
The survival benefit was particularly evident among patients with adenocarcinoma vs. squamous cell carcinoma.
“Given known advances in adenocarcinoma treatment compared with squamous cell lung cancer [between 1998 and 2010], our study suggests potential treatment-related disparities may exist between academic centers and community centers,” Sendhilnathan Ramalingam, MD, trainee in the department of hematology-oncology at Duke Cancer Institute, and colleagues wrote.
Ramalingam and colleagues used the National Cancer Database to examine whether treatment received at an academic center was linked to a survival advantage after the introduction of novel targeted therapies between 1998 and 2010 that require a molecularly driven, histologically specific approach.
The study included 193,279 patients (mean age, 63.5 years; 56.7% men; 84.3% white) with clinical or pathologic stage IV NSCLC.
The primary endpoint was 2-year survival — assessed by multivariable regression model controlling for age, year of diagnosis, gender, primary payer, histology, facility type and an interaction term allowing a time-based comparison between academic and community centers.
Two-year survival was 11.5% among patients who received treatment at academic centers and 9.2% among those who received treatment at community centers in 1998.
By 2010, 2-year survival increased to 17.4% among those treated at academic centers and 13.1% among those treated at community centers.
Results of multivariable analysis confirmed a significant relative increase in 2-year survival associated with academic centers vs. community centers from 1998 to 2010 (P = .0005).
Researchers also observed a difference in histology-dependent survival between patients with adenocarcinoma vs. squamous cell carcinoma (10.2% vs. 9.9% in 1998; 17.3% vs. 10.1% in 2010).
From 1998 to 2010, 2-year survival among patients with adenocarcinoma increased from 12.3% to 20.5% across academic centers and from 9.1% to 15.5% across community centers. Researchers observed a trend toward significance in a multivariable model (P = .005).
“Further study will be needed to validate this disparity in health care and address opportunities to improve survival in stage IV NSCLC patients across treatment setting,” Ramalingam and colleagues wrote. – by Jennifer Southall
Disclosures: All authors report no relevant financial disclosures.