Clinical Significance of Time‐to‐Surgery and COVID‐19 Pandemic in Surgically Treated Non‐Small Cell Lung Cancer

Ghimessy, Áron and Fillinger, János and Csaba, Márton and Lality, Sára and Tarsoly, Gábor and Tihanyi, Hanna and Csende, Kristóf and Radeczky, Péter and Gieszer, Balázs and Bogyó, Levente and Török, Klára and Mészáros, László and Gellért, Áron and Ferencz, Bence and Döme, Balázs and Kocsis, Ákos and Agócs, László and Rényi‐Vámos, Ferenc and Megyesfalvi, Zsolt (2025) Clinical Significance of Time‐to‐Surgery and COVID‐19 Pandemic in Surgically Treated Non‐Small Cell Lung Cancer. THORACIC CANCER, 16 (17). No. e70163. ISSN 1759-7706 (In Press)

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Abstract

Objectives: Timely discovery and adequate patient management are crucial in non-small cell lung cancer (NSCLC) since longterm survival is only achievable in early-stage disease. In our study, we aimed to elucidate the effects of time to surgery on survival and to assess the impact of the COVID-19 pandemic on elapsed time until surgery. Methods: In total, 2536 Caucasian NSCLC patients who underwent curative-intent lung resection surgery were included in this study. 1month, 2months, 77days, and 91.06days between CT-based diagnosis and surgery were evaluated as possible cutoff values for worse outcome. Survival curves were estimated by Kaplan–Meier plots, and the differences between groups were compared using the log-rank test. Multivariate analysis was performed using a Cox regression model. Results: Patients with time-to-surgery ≥2months had significantly impaired overall survival (OS) (vs. those with <2months; p=0.002). In our multivariate model, time-to-surgery (p=0.011), age (p=0.02), diabetes mellitus (p=0.02), disease stage (p=0.0001) and vascular invasion (p<0.001) all had a significant impact on OS. Importantly, during the COVID-19 pandemic, the elapsed time between diagnosis and surgery increased with a median of 12days, resulting in a significant delay in time-tosurgery compared to the pre-pandemic period (p<0.001). Post hoc tests showed, however, that there were no significant differences in time-to-surgery concerning the major waves of COVID-19 infections. Conclusions: Time-to-surgery is an independent predictor of long-term survival in surgically treated NSCLC. In general, the COVID-19 pandemic caused a significant delay in the elapsed time until surgery, but the specific COVID-19 waves had no significant impact on time-to-surgery.

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