How Have We Diagnosed Early-Stage Lung Cancer without Radiographic Screening? A Contemporary Single-Center Experience

Taiwo, Evelyn; Yorio, Jeffrey T.; Yan, Jingsheng; Gerber, David E.

doi:10.1371/journal.pone.0052313

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…In this regard, the enormous potential of LDCT has been conclusively demonstrated by the NLST trial, which has provided a rationale for LDCT screening in high-risk ever-smokers. However, NLST selection criteria are not optimal and may exclude many patients with early lung cancer as shown in a retrospective study of patients diagnosed with stage I–II lung cancer, where just 48% met the NLST inclusion criteria for age and smoking [ 157 ]. Furthermore, one study estimated that just 26.7% of lung cancers diagnosed in the United States were covered by NLST criteria, using data from SEER (surveillance, epidemiology and end results) [ 158 ].…”

Section: Discussionmentioning

confidence: 99%

Progress and prospects of early detection in lung cancer

et al. 2017

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Lung cancer is the leading cause of cancer-related death in the world. It is broadly divided into small cell (SCLC, approx. 15% cases) and non-small cell lung cancer (NSCLC, approx. 85% cases). The main histological subtypes of NSCLC are adenocarcinoma and squamous cell carcinoma, with the presence of specific DNA mutations allowing further molecular stratification. If identified at an early stage, surgical resection of NSCLC offers a favourable prognosis, with published case series reporting 5-year survival rates of up to 70% for small, localized tumours (stage I). However, most patients (approx. 75%) have advanced disease at the time of diagnosis (stage III/IV) and despite significant developments in the oncological management of late stage lung cancer over recent years, survival remains poor. In 2014, the UK Office for National Statistics reported that patients diagnosed with distant metastatic disease (stage IV) had a 1-year survival rate of just 15–19% compared with 81–85% for stage I.

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Section: Discussionmentioning

confidence: 99%

Progress and prospects of early detection in lung cancer

et al. 2017

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“…Because a decreasing proportion of early stage lung cancers are initially detected due to symptoms, 5 increasingly they are detected incidentally during radiographic evaluation performed for other reasons. Patients with medical comorbidities may be more likely to undergo such imaging studies, 37 whether as a component of routine disease surveillance, preoperative screening for surgical procedures, or during acute hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…1–4 Earlier work at our institution has demonstrated that the reason for initial imaging and diagnosis, timeliness of diagnostic evaluation and therapy, treatment selection, and overall survival in patients with early stage and locally advanced disease differ according to socioeconomic status. 5–8 Reasons for these disparities remain unclear. Potential explanations include system-level factors, provider preferences, patient preferences, and patient fitness for therapy.…”

Section: Introductionmentioning

confidence: 99%

Influence of Medical Comorbidities on the Presentation and Outcomes of Stage I-III Non–Small-Cell Lung Cancer

Ahn

Mehta

Yorio

et al. 2013

Clinical Lung Cancer

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Background Non-small cell lung cancer (NSCLC) presentation, treatment, and outcomes vary widely according to socioeconomic factors and other patient characteristics. To determine whether medical comorbidities account for these observations, we incorporated a validated medical comorbidity index into an analysis of patients diagnosed with stage I–III NSCLC. Patients and Methods We performed a retrospective analysis of consecutive patients diagnosed with stage I–III NSCLC. Demographic, tumor, and comorbidity data were obtained from hospital tumor registries and individual patient records. The association between variables was assessed through multivariate logistic regression and survival analysis. Results A total of 454 patients met criteria for analysis. Median age was 65 years, and 51% were men. Individuals with a higher Charlson Comorbidity Index (CCI) were significantly more likely to present with early stage (stage I–II) NSCLC than were patients with lower CCI (OR 1.72; 95% CI, 1.14 to 2.63; P=0.01), although this association lost statistical significance (P=0.21) in a multivariate model. In multivariate logistic regression, overall survival remained associated with all variables: age, gender, race, insurance type, stage, histology, and CCI (P=0.0007). The CCI was associated with survival for patients with both early stage (P=0.02) and locally advanced (P=0.02) disease. Conclusions In this cohort of patients with stage I–III NSCLC, increasing comorbidity burden had a non-significant association with diagnosis at earlier disease stage. Although comorbidity burden was significantly associated with outcome for both early stage and locally advanced disease, it did not account for survival differences based on multiple other patient and disease characteristics.

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“…Hence, in the meantime, much attention has also been paid to symptoms, especially initial respiratory symptoms, that may indicate the incidence of lung cancer 10 - 12 . It was suggested that many patients with lung cancer had subtle shifts in symptoms when they were diagnosed and the majority of them were actually caused by the cancer 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of and risk factors for presenting initial respiratory symptoms in patients undergoing surgery for lung cancer

Wang

et al. 2018

J. Cancer

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Background: Patients with early stage lung cancer seldom present initial respiratory symptoms, causing a delayed diagnosis and missed opportunity to receive operation. This study aimed to investigate the prevalence of initial respiratory symptoms and identity what factors would predispose lung cancer patients to present initial respiratory symptoms in patients undergoing lung cancer surgery.Methods: A retrospective chart review was conducted on 3,203 patients undergoing surgery for primary lung cancer. The prevalence of initial respiratory symptoms was investigated and the comparisons of clinicopathological parameters were performed between patients with and without initial respiratory symptoms or between patients with single and multiple initial respiratory symptoms. Independent risk factors for presenting initial respiratory symptoms or multiple initial respiratory symptoms were identified using a logistic regression.Results: A total of 1,474 (46.0%) patients with lung cancer were admitted to hospital due to present initial respiratory symptoms. Symptom clusters of cough or sputum (33.1%) and bloody sputum or hemoptysis (16.7%) presented as the two major chief complaints for medical consultation while chest pain (6.9%) and chest distress or dyspnea (5.6%) remained relatively unusual. Multiple analyses found that coexisting chronic obstructive pulmonary disease (OR=1.70, 95% CI=1.41—2.05), tumor size >3 cm (OR=2.27, 95% CI=1.93—2.67), squamous cell carcinoma (OR=2.22, 95% CI=1.86—2.65), tumor located in left lower lung (OR=1.39, 95% CI=1.10—1.74) and advanced tumor stage (OR=1.27, 95% CI=1.06—1.52) were independent risk factors for presenting initial respiratory symptoms. Furthermore, current smoking (OR=1.36, 95% CI=1.07—1.73), tumor size >3 cm (OR=1.53, 95% CI=1.21—1.93) and squamous cell carcinoma (OR=1.68, 95% CI=1.32—2.15) were demonstrated to be independent risk factors for presenting multiple initial respiratory symptoms.Conclusions: Presenting initial respiratory symptoms was the common cause for medical consultation in patients undergoing lung cancer surgery. Patients with lung cancer in larger tumor size or squamous cell carcinoma more likely presented initial and even multiple initial respiratory symptoms.

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How Have We Diagnosed Early-Stage Lung Cancer without Radiographic Screening? A Contemporary Single-Center Experience

Cited by 8 publications

References 22 publications

Progress and prospects of early detection in lung cancer

Progress and prospects of early detection in lung cancer

Influence of Medical Comorbidities on the Presentation and Outcomes of Stage I-III Non–Small-Cell Lung Cancer

Prevalence of and risk factors for presenting initial respiratory symptoms in patients undergoing surgery for lung cancer

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