TY - JOUR
T1 - Impact on Prognosis of Stage I Non–Small Cell Lung Cancer Secondary to Delays in Diagnostic Workup
AU - Yankelevitz, David F.
AU - Yip, Rowena
AU - Henschke, Claudia I.
N1 - Publisher Copyright:
© RSNA, 2024.
PY - 2024/10
Y1 - 2024/10
N2 - Background: Diagnostic workup of small pulmonary nodules often requires follow-up CT scans to confirm nodule growth before invasive diagnostics or treatment. Purpose: To confirm prior results from the International Early Lung Cancer Action Program (I-ELCAP) on quantifying decreases in lung cancer prognosis by using two large databases, the National Lung Screening Trial (NLST) and International Association for the Study of Lung Cancer (IASLC). Materials and Methods: In this retrospective study, a model was developed to predict cure rates based on size of solid nodules using the NLST (August 2002 to summer 2007) and IASLC (January 2011 to December 2019) databases, focusing on stage I non–small cell lung cancer (NSCLC). Kaplan-Meier methods were used to calculate 10-year lung cancer–specific survival and 5-year overall survival rates for different tumor sizes. Tumor diameter increases after 90-, 180-, and 365-day delays were estimated using volume doubling times (VDTs) of 60, 120, and 240 days corresponding to fast, moderate, and slow tumor growth. Initial and delayed lung cancer cure rates were assessed across nine scenarios of time delays and tumor growth rates and compared with the previous results of the I-ELCAP database. Results: Using regression models based on 166 NLST and 22 590 IASLC patients with NSCLC, 10-year lung cancer–specific survival and 5-year overall survival, respectively, for tumors 4.0–20.0 mm in diameter were estimated. For a 20.0-mm tumor with a 60-day VDT in the NLST database, the lung cancer–specific survival decreased from 83.4% to 76.5%, 66.8%, and 32.3% after 90, 180, and 365 days, respectively. The IASLC database showed similar decreases in 5-year overall survival, from 81.2% to 73.4%, 62.4%, and 23.3% after 90, 180, and 365 days, respectively. Comparison across NLST, IASLC, and I-ELCAP databases revealed minor variations in lung cancer cure rates between 79.9% and 83.4%, with reductions of 6.9%–8.3% after a 180-day delay with a 120-day VDT. Conclusion: The NLST and IASLC databases confirmed prior estimates from the I-ELCAP database for the decrease in lung cancer prognosis due to diagnostic delays.
AB - Background: Diagnostic workup of small pulmonary nodules often requires follow-up CT scans to confirm nodule growth before invasive diagnostics or treatment. Purpose: To confirm prior results from the International Early Lung Cancer Action Program (I-ELCAP) on quantifying decreases in lung cancer prognosis by using two large databases, the National Lung Screening Trial (NLST) and International Association for the Study of Lung Cancer (IASLC). Materials and Methods: In this retrospective study, a model was developed to predict cure rates based on size of solid nodules using the NLST (August 2002 to summer 2007) and IASLC (January 2011 to December 2019) databases, focusing on stage I non–small cell lung cancer (NSCLC). Kaplan-Meier methods were used to calculate 10-year lung cancer–specific survival and 5-year overall survival rates for different tumor sizes. Tumor diameter increases after 90-, 180-, and 365-day delays were estimated using volume doubling times (VDTs) of 60, 120, and 240 days corresponding to fast, moderate, and slow tumor growth. Initial and delayed lung cancer cure rates were assessed across nine scenarios of time delays and tumor growth rates and compared with the previous results of the I-ELCAP database. Results: Using regression models based on 166 NLST and 22 590 IASLC patients with NSCLC, 10-year lung cancer–specific survival and 5-year overall survival, respectively, for tumors 4.0–20.0 mm in diameter were estimated. For a 20.0-mm tumor with a 60-day VDT in the NLST database, the lung cancer–specific survival decreased from 83.4% to 76.5%, 66.8%, and 32.3% after 90, 180, and 365 days, respectively. The IASLC database showed similar decreases in 5-year overall survival, from 81.2% to 73.4%, 62.4%, and 23.3% after 90, 180, and 365 days, respectively. Comparison across NLST, IASLC, and I-ELCAP databases revealed minor variations in lung cancer cure rates between 79.9% and 83.4%, with reductions of 6.9%–8.3% after a 180-day delay with a 120-day VDT. Conclusion: The NLST and IASLC databases confirmed prior estimates from the I-ELCAP database for the decrease in lung cancer prognosis due to diagnostic delays.
UR - http://www.scopus.com/inward/record.url?scp=85206961457&partnerID=8YFLogxK
U2 - 10.1148/radiol.240420
DO - 10.1148/radiol.240420
M3 - Article
C2 - 39436291
AN - SCOPUS:85206961457
SN - 0033-8419
VL - 313
JO - Radiology
JF - Radiology
IS - 1
M1 - e240420
ER -