Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Objective: Routine surveillance imaging for patients with resected non–small cell lung cancer is standard for the detection of disease recurrence and new primary lung cancers. However, surveillance intensity varies widely in practice, and its influence on long-term outcomes is poorly understood. We hypothesized that surveillance intensity was not associated with 5-year overall survival in patients with resected stage I non–small cell lung cancer. Additionally, we examined patterns of recurrence and new primary lung cancer development. Methods: Cancer registrars at the Commission on Cancer accredited institutions re-abstracted records to augment National Cancer Database patient data with information on comorbidities, imaging surveillance including intent and result of imaging, and recurrence (2007-2012). Pathologic stage I non–small cell lung cancer patients undergoing computed tomography surveillance were placed into 3 imaging surveillance groups based on clinical practice guidelines: high intensity (3 month), moderate intensity (6 month), and low intensity (annual). Kaplan-Meier analysis and Cox regression were used to compare overall survival among the 3 surveillance groups. Results: Two thousand four hundred forty-two patients were identified, with 805 (33%), 1216 (50%), and 421 (17%) patients in the high, moderate, and low surveillance intensity groups, respectively. Five-year overall survival was similar between intensity groups (P =.547). Surveillance on asymptomatic patients detected 210 (63%) cases of locoregional recurrences and 128 (72%) cases of new primary lung cancer. Conclusions: In a unique national dataset of long-term outcomes for stage I non–small cell lung cancer, surveillance intensity was not associated with 5-year overall survival.