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

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.