Institutional-level differences in the quality of care of patients with NSCLC are associated with differences in stage-stratified and overall survival (OS), according to results presented at the International Association for the Study of Lung Cancer (IASLC) 17th Annual World Conference on Lung Cancer in Austria.1

Researchers analyzed stage-stratified and OS of patients at different institutions to quantify institutional differences in quality measures and estimate their relative survival impact. Based on the results, they identified the most important targets for improvement efforts.

The researchers grouped National Cancer Data Base (NCDB) institutions according to their American College of Surgeons Commission on Cancer (COC) accreditation and categorization. Categories included: Community Cancer Program (CCP), Comprehensive Community Cancer Program (CCCP), Teaching Research Program (TRP), and NCI Program/Network (NCIP).

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They examined data on quality parameters for resections performed within each category of institution for patients with stage I through stage IIIA NSCLC in the NCDB from 2004-2013. Of 125,408 eligible patients, 8% received surgery at CCP, 52% at CCCP, 28% at TRP, and 12% at NCIP. 

The researchers found “striking differences” in the quality and accuracy of NSCLC pathologic nodal staging between the different categories of COC-accredited treatment facilities. They also found significantly higher quality stage-stratified OS in institutions with higher quality staging. The difference in survival disappeared among patients who did not have examination of lymph nodes, who they wrote “arguably have similarly bad quality pathologic nodal staging.”

Adjusting for other measures of pathologic nodal staging quality did not, however, eliminate the survival disparity among institutions.

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The researchers recommended further investigation of the practice differences among institutions to better understand how institutional differences affect survival following resection for NSCLC.


  1. Osarogiagbon RU, Lin CC, Smeltzer MP, Jemal A. Institutional-based differences in the quality and outcomes of US lung cancer resections. Paper presented at: International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer; December 2016; Vienna, Austria.