title: Imaging surveillance and survival for surgically resected non-small-cell lung cancer.
abstract: BACKGROUND
  The importance of imaging surveillance after treatment for lung cancer is not well characterized. We examined the association between initial guideline recommended imaging surveillance and survival among early-stage resected non-small-cell lung cancer (NSCLC) patients.
  
  
  METHODS
  A retrospective study was conducted using Surveillance, Epidemiology, and End Results-Medicare data (1995-2010). Surgically resected patients, with stage I and II NSCLC, were categorized by imaging received during the initial surveillance period (4-8 mo) after surgery. Primary outcome was overall survival. Secondary treatment interventions were examined as intermediary outcomes.
  
  
  RESULTS
  Most (88%) patients had at least one outpatient clinic visit, and 24% received an initial computerized tomography (CT) during the first surveillance period. Five-year survival by initial surveillance imaging was 61% for CT, 58% for chest radiography, and 60% for no imaging. After adjustment, initial CT was not associated with improved overall survival (hazard ratio [HR], 1.04; 95% confidence interval [CI] 0.96-1.14). On subgroup analysis, restricted to patients with demonstrated initial postoperative follow-up, CT was associated with a lower overall risk of death for stage I patients (HR, 0.85; 95% CI, 0.74-0.98), but not for stage II (HR, 1.01; 95% CI, 0.71-1.42). There was no significant difference in rates of secondary interventions predicted by type of initial imaging surveillance.
  
  
  CONCLUSIONS
  Initial surveillance CT is not associated with improved overall or lung cancer-specific survival among early-stage NSCLC patients undergoing surgical resection. Stage I patients with early follow-up may represent a subpopulation that benefits from initial surveillance although this may be influenced by healthy patient selection bias.
authors.affiliation: Surgery Service, VA Palo Alto Health Care System, Palo Alto, California; Department of Cardiothoracic Surgery, Stanford University, Stanford, California. Electronic address: lbackhus@stanford.edu.
authors.forename: Leah M
authors.initials: LM
authors.lastname: Backhus
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Chao-Kang Jason
authors.initials: CK
authors.lastname: Liang
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Hao
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Varghese
authors.affiliation: Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, Washington; Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington; Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Cancer follow-up; Guidelines; Imaging surveillance; Lung cancer survival