title: Multidisciplinary Treatment for Stage IIIA Non-Small Cell Lung Cancer: Does Institution Type Matter?
abstract: BACKGROUND
  Improved survival of patients with early-stage non-small cell lung cancer (NSCLC) undergoing resection at high-volume centers has been reported. However, the effect of institution is unclear in stage IIIA NSCLC, where a variety of neoadjuvant and adjuvant therapies are used.
  
  
  METHODS
  Treatment and outcomes data of clinical stage IIIA NSCLC patients undergoing resection as part of multimodality therapy was obtained from the National Cancer Database. Multivariable regression models were fitted to evaluate variables influencing 30-day mortality and overall survival.
  
  
  RESULTS
  From 1998 to 2010, 11,492 clinical stage IIIA patients underwent resection at community centers, and 7,743 patients received resection at academic centers. Academic center patients were more likely to be younger, female, non-Caucasian, have a lower Charlson-Deyo comorbidity score, and to receive neoadjuvant chemotherapy (49.6% vs 40.6%; all p < 0.001). Higher 30-day mortality was associated with increasing age, male gender, preoperative radiotherapy, and pneumonectomy. Patients undergoing operations at academic centers experienced lower 30-day mortality (3.3% vs 4.5%; odds ratio, 0.75; 95% confidence interval [CI], 0.60 to 0.93; p < 0.001). Decreased long-term survival was associated with increasing age, male gender, higher Charlson-Deyo comorbidity score, and larger tumors. Neoadjuvant chemotherapy (hazard ratio, 0.66; 95% CI, 0.62 to 0.70), surgical intervention at an academic center (hazard ratio, 0.92; 95% CI, 0.88 to 0.97), and lobectomy (hazard ratio, 0.72; 95% CI, 0.67 to 0.77) were associated with improved overall survival.
  
  
  CONCLUSIONS
  Stage IIIA NSCLC patients undergoing resection at academic centers had lower 30-day mortality and increased overall survival compared with patients treated at community centers, possibly due to higher patient volume and an increased rate of neoadjuvant chemotherapy.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Pamela
authors.initials: P
authors.lastname: Samson
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Aalok
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Traves D
authors.initials: TD
authors.lastname: Crabtree
authors.affiliation: Division of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morgensztern
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Cliff G
authors.initials: CG
authors.lastname: Robinson
authors.affiliation: Institute for Public Health, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.affiliation: Division of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Saiama
authors.initials: S
authors.lastname: Waqar
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: A Sasha
authors.initials: AS
authors.lastname: Krupnick
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Stephen
authors.initials: S
authors.lastname: Broderick
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri. Electronic address: puriv@wudosis.wustl.edu.
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006268:Health Facilities / Q000145:classification; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D015996:Survival Rate