Effect of EBUS timing on delays and survival in non-small cell lung cancer

Our aim was to analyse whether the timing of endobronchial ultrasound (EBUS) influenced delay times and survival in patients with non-small cell lung cancer (NSCLC).

We included all patients diagnosed with NSCLC, prospectively collected in an anonymized database, who underwent EBUS and Positron Emission Tomography (PET). Patients were categorized as EBUSpre (EBUS before PET) or EBUSpost (EBUS after PET). Delay time (DT) was defined as the interval from first contact with specialized healthcare to therapeutic decision. Survival was estimated with Kaplan-Meier curves, and factors associated with delay and survival were identified through logistic regression and Cox proportional hazards models.

190 patients were included, 66 EBUSpre (TNM stage by CT: 48 I-IIIA, 14 III-B, 4 III-C), six of whom (9.2 %) were classified as stage IV by PET. The mean DT was 61.8 ± 31.8 days, significantly shorter in EBUSpre than in EBUSpost (53.5 ± 27.0 vs. 66.9 ± 33.5 days; p = 0.01). In multivariate analysis, EBUSpre remained independently associated with shorter delays [OR = 0.43; 95 % CI 0.23-0.81; p = 0.009], while outpatient setting was linked to longer delays [OR = 2.45; 95 % CI 1.17-5.11; p = 0.004]. Overall median survival was 90 weeks, with no difference between groups, except in stage IIIA patients, where survival was significantly longer in EBUSpre (124 vs 90 weeks; p = 0.04). In Cox regression, both EBUS timing and treatment were independently associated with survival.

In NSCLC, performing EBUS early-without awaiting PET-significantly reduces delays and may improve survival in stage IIIA.