Prognostic value of short-term global health score decline after lung resection or stereotactic ablative radiotherapy for stage IA NSCLC

Early-stage non-small cell lung cancer (NSCLC) is increasingly treated with either video-assisted thoracoscopic surgery (VATS) or stereotactic ablative radiotherapy (SABR). The British prospective observational Life after Lung Cancer (LiLac) study investigated the association of short-term global health (GH) score decline with long-term survival after VATS or SABR for stage IA NSCLC. A total of 142 patients were included (80 VATS, 62 SABR). Quality of life was assessed using the EORTC QLQ-C30 and LC13 at baseline and at 6 weeks, 3, 6, and 12 months. The median follow-up was 59 months. Overall survival and event-free survival at 5 years were higher in surgical patients, whereas lung-cancer specific survival showed a favorable trend for VATS. A GH score decline more that 10 points at 6 weeks was the only factor independently associated with lung cancer-specific death (sHR 5.77; p=0.019), irrespective of treatment modality. The authors conclude that early decline in patient-reported GH status after curative treatment for stage I NSCLC is a strong independent predictor of lung cancer-specific mortality.