ESTIMATING RECURRENCE AFTER LUNG CANCER RESECTION USING CLAIMS DATA: A COMPETING RISKS ANALYSIS IN CHINA
Author(s)
Yue Xu, PhD student1, Xiaozhu An, Master student1, Ziyun Hu, Master student1, Dawei Yang, PhD2, Wen Chen, PhD1, MIN HU, PhD1.
1School of Public Health, Fudan University, Shanghai, China, 2Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
1School of Public Health, Fudan University, Shanghai, China, 2Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
OBJECTIVES: Population-level estimates of postoperative lung cancer recurrence are limited in China, particularly in real-world settings where death before recurrence may preclude its observation. This study aimed to estimate the cumulative incidence of postoperative recurrence and death before recurrence after lung cancer resection and to identify baseline factors associated with recurrence.
METHODS: This retrospective population-based cohort study used health insurance claims data from adults who underwent surgical resection for primary lung cancer in a major metropolitan area of Eastern China, from 2022 to 2024. The date of surgery was the time origin. The primary outcome was postoperative recurrence, identified using a claims-based algorithm incorporating metastatic diagnosis codes and treatment-based triggers (surgery, radiotherapy, chemotherapy, and ablation). Death before recurrence was treated as a competing event. Recurrence and pre-recurrence death were estimated using cumulative incidence functions. Associations with recurrence were estimated using multivariable Fine-Gray subdistribution hazard models and cause-specific Cox models.
RESULTS: Among 7,945 patients, 1,224 (15.4%) experienced recurrence and 999 (12.6%) died before recurrence. The 12-month and 24-month cumulative incidence of recurrence was 10.6% and 14.7%, with corresponding death-before-recurrence incidence of 2.5% and 7.6%. In Fine-Gray models, each 10-year increase in age (subdistribution hazard ratio [SHR], 1.34; 95% CI, 1.27-1.42), male sex (SHR, 1.46; 95% CI, 1.31-1.64), and a non-cancer Charlson Comorbidity Index of 2 or higher (SHR, 1.57; 95% CI, 1.30-1.91) were associated with higher recurrence risk. Insurance type was not associated with recurrence.
CONCLUSIONS: To our knowledge, this study provides among the first population-based estimates of post-resection lung cancer recurrence derived from health insurance claims data in China. These findings can inform recurrence risk communication, risk-stratified follow-up, and future outcomes research in lung cancer care.
METHODS: This retrospective population-based cohort study used health insurance claims data from adults who underwent surgical resection for primary lung cancer in a major metropolitan area of Eastern China, from 2022 to 2024. The date of surgery was the time origin. The primary outcome was postoperative recurrence, identified using a claims-based algorithm incorporating metastatic diagnosis codes and treatment-based triggers (surgery, radiotherapy, chemotherapy, and ablation). Death before recurrence was treated as a competing event. Recurrence and pre-recurrence death were estimated using cumulative incidence functions. Associations with recurrence were estimated using multivariable Fine-Gray subdistribution hazard models and cause-specific Cox models.
RESULTS: Among 7,945 patients, 1,224 (15.4%) experienced recurrence and 999 (12.6%) died before recurrence. The 12-month and 24-month cumulative incidence of recurrence was 10.6% and 14.7%, with corresponding death-before-recurrence incidence of 2.5% and 7.6%. In Fine-Gray models, each 10-year increase in age (subdistribution hazard ratio [SHR], 1.34; 95% CI, 1.27-1.42), male sex (SHR, 1.46; 95% CI, 1.31-1.64), and a non-cancer Charlson Comorbidity Index of 2 or higher (SHR, 1.57; 95% CI, 1.30-1.91) were associated with higher recurrence risk. Insurance type was not associated with recurrence.
CONCLUSIONS: To our knowledge, this study provides among the first population-based estimates of post-resection lung cancer recurrence derived from health insurance claims data in China. These findings can inform recurrence risk communication, risk-stratified follow-up, and future outcomes research in lung cancer care.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
RWD2
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology