TOPLINE:

In a retrospective analysis, 34% of patients with stage I-IIIA non-small cell lung cancer 
(NSCLC) did not undergo surgery due to key factors such as old age, comorbidities, and reduced lung function.

METHODOLOGY:

• Researchers conducted a retrospective study that analysed real-world data of 524 patients with stage I-IIIA NSCLC (mean age at diagnosis, 71.6 years; 58.4% women) registered in 2022 from the Danish Lung Cancer Registry.
• Patients were dichotomised into surgery (n = 346; 66%) and no-surgery (n = 178; 34%) groups, with video-assisted thoracoscopic surgery performed in 96.8% of surgical cases and stereotactic body radiation therapy used in 59% of non-surgical cases.
• The association of age, stage of the disease, Eastern Cooperative Oncology Group performance status (ECOG-PS), comorbidities, and lung function with non-surgical management was evaluated. Overall survival was measured from diagnosis until the earliest of death or the end of observation on August 30, 2024.

TAKEAWAY:

• Non-surgical management had significant positive associations with the age of 80-89 years (odds ratio [OR], 1.298; 95% CI, 1.179-1.429), stage IIIA disease (OR, 1.181; 95% CI, 1.059-1.315), ECOG-PS scores of 1 (OR, 1.272; 95% CI, 1.138-1.421) and 2 (OR, 1.443; 95% CI, 1.046-1.991), comorbidities (OR, 1.116; 95% CI, 1.015-1.227), and cases in which the diffusing capacity of the lung for carbon monoxide was unregistered (OR, 1.322; 95% CI, 1.137-1.537).
• One-year overall survival rates were significantly higher in the surgery group than in the no-surgery group (95.7% vs 82.0%; P < .0001).
• Researchers found no documentation of preoperative exercise testing in any patient records, despite it being recommended in clinical guidelines.
• The most common reasons for non-surgical management were low lung function or poor PS (29.2%), comorbidities (18.0%), and N2 disease (11.8%), with 19.7% of cases having no documented justification.

IN PRACTICE:

"While these findings align with previous registry-based studies, a new insight from this study is its documentation of the rationale for non-operative treatment, as recorded in the MDT [multidisciplinary team conference] decision-making process — an aspect that, to our knowledge, has not been explored in prior studies," the authors wrote, adding that "it may be relevant to investigate whether a more objective assessment of patients' functional status through the systematic use of exercise or functional tests in the evaluation of patients with lung cancer could contribute to assessing their suitability for surgery."

SOURCE:

This study was led by Thomas Budolfsen, UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. It was published online on January 15, 2026, in the European Journal of Cancer.

LIMITATIONS:

This study did not account for competing risks. The retrospective design limited the ability to draw causal relationships. The focus on a single region in Denmark may have limited generalisability to other healthcare systems. Socioeconomic data were unavailable, potentially resulting in residual confounding. The 1-year follow-up period provided only a limited view of long-term outcomes, and the lack of adjusted survival analyses due to data structure constraints affected the interpretation of survival differences between the two groups.

DISCLOSURES:

This study was funded by the Danish Research Center for Cancer Surgery, Danish Cancer Society, and Danish Comprehensive Cancer Center. One author reported receiving financial support from the Danish Research Center for Cancer Surgery, and three authors reported having financial relationships with AstraZeneca, MSD, or various other sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.