Hospital Variation in Invasive Mediastinal Staging for Patients With Stage I Lung Cancer Treated With Radiation.

Area of Science:

• Oncology
• Medical Imaging
• Public Health

Background:

• Invasive mediastinal staging (IMS) use before radiation therapy for early-stage lung cancer is inconsistent.
• The drivers of this variability and its impact on patient outcomes remain unclear.

Purpose of the Study:

• To analyze national variations in IMS rates for early-stage lung cancer patients undergoing radiation therapy.
• To determine if hospital-level IMS rates affect patient survival.

Main Methods:

• Utilized the National Cancer Database (2004-2022) for stage I non-small cell lung cancer patients treated with radiation.
• Employed hierarchical regression to adjust IMS rates for patient, tumor, and hospital factors.
• Conducted Kaplan-Meier survival analysis to compare outcomes across hospital quintiles based on adjusted IMS rates.

Main Results:

• Analyzed 34,879 patients treated at 1,210 hospitals; 11.5% received IMS (76.2% endobronchial ultrasound).
• Significant hospital variation in IMS rates (0%-100%) persisted after risk/reliability adjustment (lowest quintile 13.2%, highest 18.5%).
• Hospitals with lower IMS rates showed reduced median survival (46 months vs. 54 months).

Conclusions:

• Wide variation in IMS use for early-stage lung cancer is not explained by patient or tumor characteristics.
• Higher rates of invasive mediastinal staging correlate with improved overall survival in these patients.