Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-small Cell Lung Cancer, Stage I, II, and IIIA

Rens, Marcel Th. M. van; Bosch, Jules M.M. van den; Rivière, Aart Brutel de la; Elbers, Hans R.J.

doi:10.1378/chest.117.2.374

Cited by 238 publications

(137 citation statements)

References 22 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…2 In addition to preventing lung cancer by promoting smoking cessation, the challenge is to help earlier diagnosis, since prognosis varies according to the stage of cancer at presentation. 3 Earlier diagnosis of lung cancers could be improved by a combination of systematic screening of high-risk individuals using spiral CT (computerised tomography) scanning, particularly where there is likely to be a favourable benefit-to-harm ratio, [4][5][6] and by facilitating the earlier investigation and referral of high-risk symptomatic individuals who present to their family physician. Cancer symptoms present a very real challenge for family physicians, since the symptoms can be common and nonspecific, making it difficult to reliably distinguish patients who need further investigation from those who can be reassured.…”

Section: Introductionmentioning

confidence: 99%

Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm

2011

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm

2011

View full text Add to dashboard Cite

“…[2][3][4][5][6][7][8][9] Studies conducted in the last decade have provided evidence that adjuvant chemotherapy after surgical resection improves outcomes for patients with resected stages II and IIIA disease and selected patients with stage I (large tumor size) NSCLC. [10][11][12][13][14] A recent meta-analysis of these newer trials, 15 which included 5 trials and 4584 patients, found a benefit for adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of age on the efficacy of adjuvant chemotherapy for resected non–small cell lung cancer

Ganti¹,

Williams

Gajra

et al. 2015

Cancer

View full text Add to dashboard Cite

BACKGROUND: Adjuvant chemotherapy after surgical resection improves outcomes for patients with early-stage non-small cell lung cancer (NSCLC). To the authors' knowledge, there are no published prospective trials to date of adjuvant chemotherapy after surgical resection administered exclusively in older patients. In the current study, the authors sought to evaluate the efficacy of adjuvant chemotherapy in older patients in a Veterans Health Administration cohort. METHODS: Patients who underwent surgical resection for American Joint Committee on Cancer stages IB to III NSCLC between 2001 and 2011 were analyzed. Data regarding patient demographics and comorbidities, tumor characteristics, and primary treatment were collected. Patients were divided into 2 groups based on age at diagnosis: those aged <70 years and those aged 70 years. The primary exposure was use of adjuvant chemotherapy. A Cox proportional hazards model was used to estimate the significance of patient characteristics. Survival curves were estimated using the Kaplan-Meier method and group comparisons were performed using the log-rank test. RESULTS: The analysis included 7593 patients who underwent surgical resection for stage IB to stage III NSCLC. Among these, 2897 patients (38%) were aged 70 years. The percentage of older patients who received adjuvant chemotherapy was approximately one-half that of younger patients who did so (15.3% vs 31.6%; P<.0001). Carboplatin-based doublets were used most often in all patients (64.6%). Both younger patients (hazard ratio, 0.79; 95% confidence interval, 0.72-0.86) and older patients (hazard ratio, 0.81; 95% confidence interval, 0.71-0.92) were found to have a lower risk of death with receipt of adjuvant chemotherapy. CONCLUSIONS: Older patients derive a similar magnitude of benefit from adjuvant chemotherapy as younger patients and therefore adjuvant chemotherapy should not be withheld based on age alone. Cancer 2015;121:2578-85. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

show abstract

“…More than half of all cases are diagnosed at an advanced stage when surgical removal is no longer a viable treatment strategy. As a result, the overall 5-year survival rate is low, but stage-specific survival rates differ substantially by stage at presentation (van Rens et al, 2000). This raises the possibility that lung cancer may be an attractive candidate for screening, to detect disease at an early stage when treatment would be more effective.…”

mentioning

confidence: 99%

The LLP risk model: an individual risk prediction model for lung cancer

et al. 2007

View full text Add to dashboard Cite

Using a model-based approach, we estimated the probability that an individual, with a specified combination of risk factors, would develop lung cancer within a 5-year period. Data from 579 lung cancer cases and 1157 age-and sex-matched population-based controls were available for this analysis. Significant risk factors were fitted into multivariate conditional logistic regression models. The final multivariate model was combined with agestandardised lung cancer incidence data to calculate absolute risk estimates. Combinations of lifestyle risk factors were modelled to create risk profiles. For example, a 77-year-old male non-smoker, with a family history of lung cancer (early onset) and occupational exposure to asbestos has an absolute risk of 3.17% (95% CI, 1.67 -5.95). Choosing a 2.5% cutoff to trigger increased surveillance, gave a sensitivity of 0.62 and specificity of 0.70, while a 6.0% cutoff gave a sensitivity of 0.34 and specificity of 0.90. A 10-fold cross validation produced an AUC statistic of 0.70, indicating good discrimination. If independent validation studies confirm these results, the LLP risk models' application as the first stage in an early detection strategy is a logical evolution in patient care. In addition, being the most common cancer with over 1.3 million incident cases per year, lung cancer has the highest worldwide rate of cancer mortality (Parkin et al, 2005). More than half of all cases are diagnosed at an advanced stage when surgical removal is no longer a viable treatment strategy. As a result, the overall 5-year survival rate is low, but stage-specific survival rates differ substantially by stage at presentation (van Rens et al, 2000). This raises the possibility that lung cancer may be an attractive candidate for screening, to detect disease at an early stage when treatment would be more effective. Recent results from the International Early Lung Cancer Action Program would appear to support this argument (I-ELCAP Investigators et al, 2006). While the International Early Lung Cancer Action Program results are very encouraging, there are also potential negative consequences of screening, including screen-detected false positives.Although a mortality benefit from spiral CT has not yet been confirmed in ongoing, large-scale randomised studies, the need to specify a high-risk target population is well accepted, and there has been increasing interest in methods of individual risk prediction for lung cancer. Models have been developed for use within highrisk groups (Bach et al, 2003), and for the general population (van Klaveren et al, 2002), although the latter tend to rely only on age and smoking. While epidemiological risk factors usually show poor discrimination between those who do and do not develop disease (Wald et al, 1999), lung cancer is an exception in that a high proportion of cases are attributable to one risk factor, smoking. However, there is room for further improvement in that many long-term smokers do not develop lung cancer. The predictive accuracy of lung cancer ri...

show abstract

Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-small Cell Lung Cancer, Stage I, II, and IIIA

Cited by 238 publications

References 22 publications

Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm

Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm

Effect of age on the efficacy of adjuvant chemotherapy for resected non–small cell lung cancer

The LLP risk model: an individual risk prediction model for lung cancer

Contact Info

Product

Resources

About