Treatment Patterns and Outcomes in Patients with Pancoast Tumors: A National Cancer Database Analysis

INTRODUCTION: Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymphadenopathy are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation followed by surgery as standard of care. But many institutions choose upfront surgery. Our goal was to identify treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB).METHODS: The NCDB was queried from 2004 through 2017 for all patients who had undergone surgery for Pancoast tumors. Treatment patterns, including the percentage who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on patients who received upfront surgery.RESULTS: A total of 2,910 patients were included in the study. Overall 30-day and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation before surgery. Patients who received neoadjuvant chemoradiation experienced improved 90-day survival (OR 0.63, p < 0.01) and overall survival (OR 0.94, p < 0.01; Fig. 1). When analyzing patients who received upfront surgery, adjuvant chemoradiation treatment was associated with improved survival compared to no treatment after surgery (OR 0.87, p < 0.01).CONCLUSION: Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases. Neoadjuvant chemoradiation is associated with improved survival compared to upfront surgery. When surgery is performed first, adjuvant chemoradiation treatment improves survival. These results suggest significant underutilization of standard of care for patients with Pancoast tumors.