High-Frequency CT Screening Does Not Improve Outcomes After Surgery for Stage I NSCLC

Despite curative-intent resection, recurrence in early-stage non–small-cell lung cancer (NSCLC) occurs in 20% to 50% of patients within 5 years. Computed tomography (CT) surveillance is a routine component of postoperative care, with the hope that earlier detection and treatment will lead to better outcomes for patients with recurrence. However, these benefits must be weighed against the potential harms, such as anxiety, unnecessary procedures, and healthcare costs, of surveilling too frequently.

Using data from the U.S. Veterans Health Administration, researchers reviewed medical records of nearly 6,200 patients with stage 1 NSCLC who underwent surgical intervention from 2006 to 2016. Average age was 67.5 years, and most were male (96%), current smokers (62%), and white (83%). Roughly half of patients underwent low-frequency CT surveillance (<2 scans per year), and the others underwent high-frequency surveillance (≥2 scans per year).

Certain patients were more likely to undergo high-frequency imaging, including those who were former smokers (vs. current smokers; adjusted odds ratio [aOR], 1.18), those who had undergone wedge resection (vs. lobectomy; aOR, 1.21), and those who had follow-up with an oncologist (aOR, 1.43). Low-frequency imaging was associated with being Black (vs. white; aOR, 0.64).

During a median follow-up of 7.3 years, 22.0% of patients experienced disease recurrence. The median time to recurrence was 21.3 months for patients who underwent low-frequency surveillance and 23.7 months for those with high-frequency surveillance. In a multivariable analysis, high-frequency surveillance was not associated with improved recurrence-free survival (adjusted hazard ratio [aHR], 0.93; P=.22) or overall survival (aHR, 1.04; P=.35).