Annals of Surgical Oncology

, Volume 24, Issue 5, pp 1419–1427 | Cite as

Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I–II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base

  • Todd A. Pezzi
  • Abdallah S. R. Mohamed
  • Clifton D. Fuller
  • Pierre Blanchard
  • Christopher Pezzi
  • Boris Sepesi
  • Stephen M. Hahn
  • Daniel R. Gomez
  • Stephen G. Chun
Radiation Oncology



The 1998 post-operative radiotherapy meta-analysis for lung cancer showed a survival detriment associated with radiation for stage I–II resected non-small cell lung cancer (NSCLC), but has been criticized for including antiquated radiation techniques. We analyzed the National Cancer Database (NCDB) to determine the impact of radiation after margin-negative (R0) resection for stage I–II NSCLC on survival.


Adult patients from 2004 to 2014 were analyzed from the NCDB with respect to receiving radiation as part of their first course of treatment for resected stage I–II NSCLC; the primary outcome measure was overall survival.


A total of 197,969 patients underwent R0 resection for stage I–II NSCLC, and 4613 received radiation. Median radiation dose was 55 Gy with a 50–60 Gy interquartile range. On adjusted analysis, treatment at a community cancer program, sublobectomy, tumor size (3–7 cm), and pN1/Nx were associated with receiving radiation (odds ratio > 1, p < 0.05). The irradiated group had shorter median survival (45.8 vs. 77.5 months, p < 0.001), and radiation was independently associated with worse overall survival (hazard ratio (HR) 1.339, 95% confidence interval (CI) 1.282–1.399). After propensity score matching, radiation remained associated with worse overall survival (HR 1.313, 95% CI 1.237–1.394, p < 0.001).


Radiotherapy was independently associated with worse survival after R0 resection of stage I–II NSCLC in the NCDB and was more likely to be delivered in community cancer programs.


Overall Survival Propensity Score Match Supplemental Appendix National Cancer Data Base Irradiate Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are appreciative of discussion with Ying Yuan, PhD, Department of Biostatistics, MD Anderson Cancer Center. Drs. Mohamed and Fuller received funding support from the National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and the NIH/National Cancer Institute (NCI) Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program award (P50CA097007-10). Dr. Fuller received support from the Paul Calabresi Clinical Oncology Program Award (K12 CA088084-06); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD), Grant (NSF 1557679); an Elekta AB/MD Anderson Department of Radiation Oncology Seed Grant; and the Center for Radiation Oncology Research (CROR) at MD Anderson Cancer Center. Dr. Fuller has received speaker travel funding from Elekta AB. Supported in part by the NIH/NCI Cancer Center Support (Core) Grant CA016672 to the University of Texas MD Anderson Cancer Center.


The authors declare that they have no conflict of interest to report.

Supplementary material

10434_2017_5786_MOESM1_ESM.docx (96 kb)
Supplementary material 1 (DOCX 96 kb)


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Todd A. Pezzi
    • 1
  • Abdallah S. R. Mohamed
    • 2
    • 3
  • Clifton D. Fuller
    • 2
  • Pierre Blanchard
    • 2
    • 4
  • Christopher Pezzi
    • 5
  • Boris Sepesi
    • 6
  • Stephen M. Hahn
    • 2
  • Daniel R. Gomez
    • 2
  • Stephen G. Chun
    • 2
  1. 1.Baylor College of MedicineHoustonUSA
  2. 2.Division of Radiation OncologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of Clinical Oncology and Nuclear MedicineAlexandria UniversityAlexandriaEgypt
  4. 4.Department of Radiation OncologyGustave Roussy Cancer CampusVillejuifFrance
  5. 5.Department of SurgeryAbington Hospital-Jefferson HealthAbingtonUSA
  6. 6.Division of Surgery, Department of Thoracic and Cardiovascular SurgeryUniversity of Texas, MD Anderson Cancer CenterHoustonUSA

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