Table 1.
Factors associated with margin positive resection (univariate and multivariate analysis).
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|---|---|---|---|---|---|---|---|
| Categories | Patients, N(col%) | Margin- Positive Patients, N(row %) | p-value | Unadjusted OR (95% CI) | p-value | Adjusted OR (95% CI) | p-value |
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| Patient Characteristics | N=112998 | N=5335 (4.7) | |||||
| Age | |||||||
| 18–49 | 6300 (5.6) | 341 (5.4) | <.001 | 1 | 1 | ||
| 50–64 | 36940 (32.7) | 1836 (5.0) | 0.91(0.81–1.03) | 0.14 | 1(0.88–1.13) | 0.99 | |
| 65–74 | 42857 (37.9) | 1915 (4.5) | 0.82(0.73–0.92) | <.001 | 0.84(0.72–0.99) | 0.03 | |
| 75–90 | 26901 (23.8) | 1243 (4.6) | 0.85(0.75–0.96) | 0.008 | 0.89(0.76–1.05) | 0.18 | |
| Gender | |||||||
| Male | 54806 (48.5) | 2837 (5.2) | <.001 | 1 | |||
| Female | 58192 (51.5) | 2498 (4.3) | 0.82(0.78–0.87) | <.001 | 1(0.95–1.06) | 0.96 | |
| Race/Ethnicity | |||||||
| Non-Hispanic, White | 88945 (78.7) | 4111 (4.6) | <.001 | 1 | 1 | ||
| Hispanic | 2464 (2.2) | 119 (4.8) | 1.05(0.87–1.26) | 0.63 | 0.99(0.81–1.2) | 0.88 | |
| Black | 9354 (8.3) | 531 (5.7) | 1.24(1.13–1.36) | <.001 | 1.15(1.04–1.27) | 0.006 | |
| Other | 2931 (2.6) | 131 (4.5) | 0.97(0.81–1.15) | 0.70 | 0.98(0.81–1.18) | 0.80 | |
| Missing | 9304 (8.2) | 443 (4.8) | 1.03(0.93–1.14) | 0.54 | 1.05(0.94–1.16) | 0.41 | |
| Diagnosis Year | |||||||
| 2004 | 12859 (11.4) | 606 (4.7) | 0.06 | 1 | 1 | ||
| 2005 | 13891 (12.3) | 638 (4.6) | 0.97(0.87–1.09) | 0.64 | 1.02(0.9–1.14) | 0.78 | |
| 2006 | 14216 (12.6) | 662 (4.7) | 0.99(0.88–1.11) | 0.83 | 1.02(0.91–1.15) | 0.73 | |
| 2007 | 14117 (12.5) | 618 (4.4) | 0.93(0.83–1.04) | 0.19 | 0.99(0.88–1.11) | 0.81 | |
| 2008 | 14244 (12.6) | 676 (4.8) | 1.01(0.9–1.13) | 0.90 | 1.07(0.95–1.2) | 0.28 | |
| 2009 | 14193 (12.6) | 659 (4.6) | 0.99(0.88–1.1) | 0.79 | 1.04(0.93–1.17) | 0.48 | |
| 2010 | 15114 (13.4) | 791 (5.2) | 1.12(1–1.25) | 0.05 | 0.95(0.85–1.06) | 0.35 | |
| 2011 | 14364 (12.7) | 685 (4.8) | 1.01(0.91–1.13) | 0.83 | 0.89(0.79–0.99) | 0.04 | |
| Insurance | |||||||
| Uninsured | 2185 (1.93) | 133 (6.1) | <.001 | 1.32(1.1–1.59) | 0.003 | 1.07(0.88–1.3) | 0.49 |
| Medicaid | 4822 (4.27) | 274 (5.7) | 1.23(1.08–1.4) | 0.002 | 1.03(0.9–1.18) | 0.70 | |
| Younger Medicare | 6392 (5.66) | 313 (4.9) | 1.05(0.93–1.19) | 0.43 | 0.99(0.87–1.13) | 0.87 | |
| Older Medicare | 58853 (52.08) | 2723 (4.6) | 0.99(0.93–1.05) | 0.73 | 1.16(1.04–1.3) | 0.006 | |
| Government | 220 (0.19) | 10 (4.6) | 0.97(0.51–1.84) | 0.93 | 0.69(0.36–1.33) | 0.27 | |
| Private | 39028 (34.54) | 1824 (4.8) | 1 | 1 | |||
| Missing | 1498 (1.33) | 58 (3.9) | 0.82(0.63–1.07) | 0.15 | 0.86(0.65–1.13) | 0.27 | |
| Median Income–Quartile 2000 | |||||||
| <$30,000 | 14702 (13.01) | 751 (5.1) | <.001 | 1.19(1.09–1.3) | <.001 | 1.09(0.98–1.21) | 0.11 |
| $30,000– $34,999 | 20829 (18.43) | 1079 (5.2) | 1.21(1.12–1.31) | <.001 | 1.14(1.04–1.24) | 0.004 | |
| $35,000– $45,999 | 31072 (27.5) | 1498 (4.8) | 1.12(1.05–1.21) | 0.001 | 1.05(0.98–1.14) | 0.18 | |
| $46,000+ | 40252 (35.62) | 1736 (4.3) | 1 | 1 | |||
| Missing | 6143 (5.44) | 271 (4.4) | 1.02(0.9–1.17) | 0.72 | 1.08(0.89–1.31) | 0.46 | |
| Rural/Urban | |||||||
| Rural | 21159 (18.73) | 1030 (4.9) | 0.20 | 1.03(0.96–1.11) | 0.35 | 0.9(0.83–0.98) | 0.01 |
| Urban | 84715 (74.97) | 3995 (4.7) | 1 | 1 | |||
| Unknown | 7124 (6.3) | 310 (4.4) | 0.92(0.82–1.04) | 0.16 | 0.98(0.82–1.17) | 0.81 | |
| Comorbidity | |||||||
| 0 | 53437 (47.29) | 2454 (4.6) | 0.11 | 1 | 1 | ||
| 1 | 40806 (36.11) | 1993 (4.9) | 1.07(1–1.13) | 0.04 | 1.07(1–1.14) | 0.05 | |
| 2+ | 18755 (16.6) | 888 (4.7) | 1.03(0.95–1.12) | 0.42 | 1.02(0.94–1.11) | 0.63 | |
| Census Region | |||||||
| Northeast | 23892 (21.14) | 946 (4.0) | <.001 | 1 | 1 | ||
| Midwest | 30404 (26.91) | 1626 (5.4) | 1.37(1.26–1.49) | <.001 | 1.55(0.93–2.6) | 0.10 | |
| South | 44324 (39.23) | 2038 (4.6) | 1.17(1.08–1.27) | <.001 | 1.17(0.74–1.86) | 0.51 | |
| West | 14250 (12.61) | 718 (5.0) | 1.29(1.17–1.42) | <.001 | 0.98(0.48–1.97) | 0.94 | |
| Missing | 128 (0.11) | 7 (5.5) | 1.4(0.65–3.01) | 0.39 | 1.45(0.61–3.45) | 0.41 | |
| Histology | |||||||
| NOS | 347 (0.31) | 18 (5.2) | <.001 | 1.37(0.85–2.2) | 0.20 | 1.05(0.65–1.72) | 0.84 |
| Large Cell | 5320 (4.71) | 261 (4.9) | 1.29(1.13–1.47) | <.001 | 0.98(0.86–1.13) | 0.78 | |
| Squamous | 33768 (29.88) | 2094 (6.2) | 1.65(1.56–1.75) | <.001 | 1.38(1.29–1.47) | <.001 | |
| Other | 5851 (5.18) | 357 (6.1) | 1.62(1.45–1.82) | <.001 | 1.34(1.19–1.51) | <.001 | |
| Adeno | 67712 (59.92) | 2605 (3.9) | 1 | 1 | |||
| Tumor Grade | |||||||
| well/moderately differentiated | 64772 (57.32) | 2528 (3.9) | <.001 | 1 | 1 | ||
| poorly/undifferentiated | 42668 (37.76) | 2557 (6.0) | 1.57(1.48–1.66) | <.001 | 1.14(1.07–1.21) | <.001 | |
| Unknown | 5558 (4.92) | 250 (4.5) | 1.16(1.02–1.33) | 0.03 | 0.98(0.85–1.13) | 0.79 | |
| Tumor Size | |||||||
| ≤3cm | 68906 (60.98) | 2136 (3.1) | <.001 | 1 | 1 | ||
| >3cm–≤5cm | 27971 (24.75) | 1706 (6.1) | 2.03(1.9–2.17) | <.001 | 1.65(1.54–1.77) | <.001 | |
| >5cm | 15518 (13.73) | 1422 (9.2) | 3.15(2.94–3.38) | <.001 | 1.94(1.79–2.1) | <.001 | |
| Unknown | 603 (0.53) | 71 (11.8) | 4.17(3.25–5.36) | <.001 | 2.47(1.89–3.22) | <.001 | |
| Lymph Node examined | |||||||
| Yes | 107002 (94.69) | 4858 (4.5) | <.001 | 1 | 1 | ||
| No | 5888 (5.21) | 467 (7.9) | 1.81(1.64–2) | <.001 | 2.14(1.9–2.41) | <.001 | |
| Unknown | 108 (0.1) | 10 (9.3) | 2.15(1.12–4.12) | 0.02 | 1.77(0.9–3.47) | 0.10 | |
| Primary Site | |||||||
| C340– Main bronchus | 725 (0.64) | 88 (12.1) | <.001 | 2.79(2.22–3.49) | <.001 | 1.4(1.1–1.78) | 0.007 |
| C341–upper lobe | 67878 (60.07) | 3207 (4.7) | 1 | 1 | |||
| C342–Middle lobe | 5451 (4.82) | 268 (4.9) | 1.04(0.92–1.19) | 0.52 | 1.19(1.04–1.35) | 0.01 | |
| C343–Lower lobe | 35317 (31.25) | 1464 (4.2) | 0.87(0.82–0.93) | <.001 | 0.83(0.78–0.89) | <.001 | |
| C348–Overlapping lesion | 1883 (1.67) | 182 (9.7) | 2.16(1.84–2.52) | 0.06 | 1.35(1.15–1.59) | <.001 | |
| C349–Lung NOS | 1744 (1.54) | 126 (7.2) | 1.57(1.31–1.89) | <.001 | 1.15(0.95–1.39) | 0.16 | |
| Pathologic Stage Group | |||||||
| Stage I | 79614 (70.46) | 1893 (2.4) | <.001 | 1 | 1 | ||
| Stage II | 21550 (19.07) | 1950 (9.1) | 4.09(3.83–4.36) | <.001 | 3.79(3.53–4.07) | <.001 | |
| Stage III | 11834 (10.47) | 1492 (12.6) | 5.92(5.52–6.36) | <.001 | 5.77(5.34–6.23) | <.001 | |
| TNM Path T #880 | |||||||
| T1 | 55320 (48.96) | 1115 (2.0) | <.001 | 1 | |||
| T2 | 48028 (42.5) | 2509 (5.2) | 2.68(2.49–2.88) | <.001 | |||
| T3 | 8300 (7.35) | 1516 (18.3) | 10.86(10.02–11.79) | <.001 | |||
| T4 | 667 (0.59) | 146 (21.9) | 13.62(11.23–16.52) | <.001 | |||
| Unknown | 683 (0.6) | 49 (7.2) | 3.76(2.79–5.06) | <.001 | |||
| TNM Path N #890 | |||||||
| N0 | 85272 (75.46) | 2818 (3.3) | <.001 | 1 | |||
| N1 | 16187 (14.33) | 1342 (8.3) | 2.65(2.47–2.83) | <.001 | |||
| N2 | 9289 (8.22) | 975 (10.5) | 3.43(3.18–3.7) | <.001 | |||
| NX | 2021 (1.79) | 178 (8.8) | 2.83(2.41–3.31) | <.001 | |||
| Unknown | 229 (0.2) | 22 (9.6) | 3.11(2–4.83) | <.001 | |||
| Extent of resection | |||||||
| Sublobar | 15671 (13.87) | 971 (6.2) | <.001 | 1.53(1.43–1.65) | <.001 | 1.96(1.80–2.15) | <.001 |
| Lobe/bilobectomy | 91017 (80.55) | 3757 (4.1) | 1 | 1 | |||
| Pneumonectomy | 6310 (5.58) | 607 (9.6) | 2.47(2.26–2.71) | <.001 | 0.98(0.89–1.09) | 0.71 | |
| Facility Characteristics Facility type | |||||||
| Community Cancer Program | 8248 (7.3) | 497 (6.0) | <.001 | 1.62(1.42–1.84) | <.001 | 1.34(1.12–1.61) | 0.002 |
| Comprehensive | 53784 (47.6) | 2647 (4.9) | <.001 | ||||
| Community Cancer Program | 1.31(1.18–1.44) | 1.23(1.1–1.38) | <.001 | ||||
| Teaching/Research | 27546 (24.38) | 1187 (4.3) | 1.14(1.02–1.26) | 0.02 | 1.06(0.95–1.19) | 0.28 | |
| NCI Program/Network | 13418 (11.87) | 512 (3.8) | 1 | 1 | |||
| 7–Other | 10002 (8.85) | 492 (4.9) | 1.3(1.15–1.48) | <.001 | 1.23(1.07–1.4) | 0.003 | |
| Proportion of Medicaid/Uninsured patients | |||||||
| Q1 (low) | 26715 (23.64) | 1157 (4.3) | 0.003 | 1 | 1 | ||
| Q2 | 30129 (26.66) | 1433 (4.8) | 1.1(1.02–1.19) | 0.02 | 1.07(0.98–1.16) | 0.13 | |
| Q3 | 31222 (27.63) | 1497 (4.8) | 1.11(1.03–1.2) | 0.008 | 1.08(0.99–1.18) | 0.07 | |
| Q4 (high) | 24932 (22.06) | 1248 (5.0) | 1.16(1.07–1.26) | <.001 | 1.13(1.03–1.24) | 0.01 | |
| Lung cancer resection as proportion of all surgery | |||||||
| Q1 (low) | 2690 (2.38) | 137 (5.1) | <.001 | 1.13(0.95–1.35) | 0.18 | 1.14(0.95–1.38) | 0.15 |
| Q2 | 22445 (19.86) | 1175 (5.2) | 1.17(1.08–1.25) | <.001 | 1.24(1.15–1.34) | <.001 | |
| Q3 | 38529 (34.1) | 1789 (4.6) | 1.03(0.96–1.09) | 0.42 | 1.09(1.02–1.16) | 0.02 | |
| Q4 (high) | 49334 (43.66) | 2234 (4.5) | 1 | 1 | |||
| Total cancer surgery volume | |||||||
| Q1 (low) | 3377 (2.99) | 206 (6.1) | <.001 | 1.45(1.26–1.68) | <.001 | 1.17(0.95–1.43) | 0.15 |
| Q2 | 13357 (11.82) | 739 (5.5) | 1.31(1.21–1.42) | <.001 | 1.17(1.05–1.3) | 0.006 | |
| Q3 | 26773 (23.69) | 1413 (5.3) | 1.25(1.17–1.33) | <.001 | 1.19(1.1–1.28) | <.001 | |
| Q4 (high) | 69491 (61.5) | 2977 (4.3) | 1 | 1 | |||
| Census Division | |||||||
| New England | 6993 (6.19) | 273 (3.9) | <.001 | 1 | 1 | ||
| Middle Atlantic | 17065 (15.1) | 681 (4.0) | 1.02(0.89–1.18) | 0.75 | 1.03(0.89–1.19) | 0.72 | |
| East North Central | 21333 (18.88) | 1182 (5.5) | 1.44(1.26–1.65) | <.001 | 0.87(0.51–1.47) | 0.59 | |
| West North Central | 9521 (8.43) | 443 (4.7) | 1.2(1.03–1.4) | 0.02 | 0.76(0.45–1.3) | 0.31 | |
| South Atlantic | 26279 (23.26) | 1124 (4.3) | 1.1(0.96–1.26) | 0.17 | 0.88(0.54–1.42) | 0.60 | |
| East South Central | 10175 (9) | 531 (5.2) | 1.36(1.17–1.57) | <.001 | 1.03(0.63–1.67) | 0.92 | |
| West South Central | 7583 (6.71) | 385 (5.1) | 1.32(1.12–1.54) | <.001 | 0.98(0.6–1.6) | 0.93 | |
| Mountain | 3628 (3.21) | 210 (5.8) | 1.51(1.26–1.82) | <.001 | 1.41(0.69–2.9) | 0.35 | |
| Pacific | 10421 (9.22) | 506 (4.9) | 1.26(1.08–1.46) | 0.003 | 1.16(0.57–2.38) | 0.68 | |
| Treatment Received radiation | |||||||
| No | 101731 (90.03) | 3000 (3.0) | <.001 | ||||
| Yes | 11267 (9.97) | 2335 (20.7) | |||||
| Received Chemotherapy | |||||||
| No | 83513 (73.91) | 2638 (3.2) | <.001 | ||||
| Yes | 29485 (26.09) | 2697 (9.2) | |||||