Does a Multi-Location CT Scan Provide a Survival Benefit as Surveillance after Curative-Intent Surgery in Early-Stage Non-Small Cell Lung Cancer?

Abstract

Purpose: The NCCN guidelines recommend a chest computed tomography (CT) scan every 6 months for 2-3 years for patients with early-stage non-small cell lung cancer (NSCLC). This study aimed to evaluate whether multi-location CT scans offer a survival benefit. Materials and Methods: This study collected clinical data for NSCLC patients who underwent curative intent surgery between 2014 and 2018. Patients were grouped by surveillance CT type: chest CT only (Group CC) or combined chest-abdominal CT (Group CA). The primary outcomes include all-cause mortality, the risk of NSCLC recurrence, and the risk of developing a second primary cancer. Multivariable time-varying Cox models adjusted for clinical factors (age, sex, stage, hospital) and six covariates, including comorbidities, smoking, MVPA, CT frequency, time since surgery, and post-op cancer diagnosis. Results: Of 32,426 patients, 23,501 were analyzed after exclusions; 22,097 were in Group CC and 1,404 in Group CA. Group CC had a higher recurrence rate (18.7% vs. 14.4%), while Group CA had higher all-cause mortality (19.7% vs. 18.0%). Adjusted Cox analysis showed higher recurrence detection in Group CA (HR 1.80, 95% CI: 1.60-2.01) and lower mortality (HR 0.82, 95% CI: 0.71-0.94) vs. Group CC among patients with recurrence or second cancers. Subgroup analysis showed higher recurrence detection in Group CA for both stages. Mortality was reduced in regional stage (HR 0.77, 95% CI: 0.64-0.93), but not in local stage (HR 1.03, 95% CI: 0.78-1.35). Conclusion: Multi-location CT surveillance after curative surgery in early-stage NSCLC, especially regional-stage, was associated with lower mortality, recurrence, and second primary cancer risk.