title: The Natural History of Operable Non-Small Cell Lung Cancer in the National Cancer Database.
abstract: BACKGROUND
  The survival of untreated non-small cell lung cancer (NSCLC), or the natural history, is an important perspective for patients considering resection for NSCLC. The National Cancer Database (NCDB) allows untreated NSCLC patients who were recommended to undergo surgical resection (ie, "operable") to be identified. The survival of untreated NSCLC patients in the NCDB was studied to determine the natural history of operable NSCLC.
  
  
  METHODS
  The NCDB was queried for untreated clinical stage I to IIIA NSCLC patients diagnosed between 2003 and 2009. The natural history cohort was defined as patients who were recommended to undergo resection but went untreated.
  
  
  RESULTS
  We identified 1,693 untreated patients with operable NSCLC. The median survival for clinical stage I, II, and IIIA was 16.6, 9.4, and 8.4 months, respectively. The 5-year Kaplan-Meier estimates of survival for clinical stage I, II, and IIIA NSCLC were 10.1%, 7.3%, and 4.9%, respectively. At each stage (I to IIIA), the survival of untreated operable NSCLC patients was superior to that of untreated NSCLC patients not recommended to undergo resection (nonoperable, p < 0.001). A multivariable Cox regression model identified increasing age, male gender, white (vs black) race, increasing comorbidity, squamous cell or large cell histology, and increasing stage as predictors of decreased survival.
  
  
  CONCLUSIONS
  The natural history of operable NSCLC, although poor, varies with clinical stage and is superior to that of nonoperable NSCLC.
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Rosen
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Hari B
authors.initials: HB
authors.lastname: Keshava
authors.affiliation: Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: daniel.boffa@yale.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology; D016208:Databases, Factual; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D016312:Treatment Refusal; D014481:United States / Q000453:epidemiology