Treatment Attrition From Surgery to Adjuvant Therapy in Stage IIB and IIIA Lung Adenocarcinoma: A National Cancer...

Lung cancer is the leading cause of cancer-related death. For pathologic stage IIB/IIIA tumors, standard of care may include surgery followed by adjuvant therapy. The proportion of patients who do not receive adjuvant therapy after surgery is not well-characterized. The goal of this study is to define the rate of treatment attrition from surgery to adjuvant therapy, identify factors associated with attrition, and elucidate trends in attrition from 2012 to 2022.

Patients with resected pathologic stage IIB/IIIA lung adenocarcinoma were included. Treatment attrition was defined as not receiving any adjuvant therapy after surgery. Trends were tested with Cochran-Armitage tests. Unadjusted and adjusted Cox proportional hazard models were used to analyze survival.

25,436 patients had pathologic stage IIB/IIIA tumors. 16,796 (66.0%) underwent adjuvant therapy, demonstrating an attrition rate of 34.0%. Attrition decreased from 37.7% in 2012 to 25.7% in 2022 (P < .001). Patient characteristics associated with attrition were age, morbidity, stage, private insurance, and having open surgery. Adjuvant therapy was associated with improved survival in unadjusted and adjusted analyses, and retained a survival benefit throughout the time period despite a changing patient profile.

Herein we define treatment attrition from surgery to adjuvant therapy in lung adenocarcinoma utilizing a large national cohort. The overall treatment attrition rate was 34.0%, although it significantly decreased over time. Adjuvant therapy was associated with a survival benefit, underscoring the importance of reducing treatment attrition to improve outcomes.