The Effect of Surgical Treatment on Survival from Early Lung Cancer

Flehinger, Betty J.; Kimmel, Marek; Melamed, Myron R.

doi:10.1378/chest.101.4.1013

Cited by 316 publications

(142 citation statements)

References 8 publications

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“…In our series (Pasini et al, 2002), as well as in other reports, at 10 years the disease-related survival decreased by 10% compared to that at 5 years (from 67 to 57%) (Flehinger et al, 1992;Ichinose et al, 1993;Harpole et al, 1995;Martini et al, 1995). Most of the recurrences occurred in the first two or three years after diagnosis; since then, however, patients continued to relapse and die at a rate of 2 -5%.…”

Section: Discussionsupporting

confidence: 60%

Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years

et al. 2003

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Among patients with non-small-cell lung cancer (NSCLC), those with pathological stage I have the best expectation of survival; however, survival is reduced to less than 50% in the long term. At present, it is unclear when patients can be reasonably defined as cured, and if they experience a higher incidence of malignant/nonmalignant diseases and a lower expectation of survival than the general population. A total of 134 stage I NSCLC patients, who had undergone resection at the Thoracic Surgery Unit of the General Hospital of Verona (north-eastern Italy) from October 1987 to December 1993, were still disease-free at 5 years. These subjects were further followed up, and morbidity and mortality rates were compared with those recorded in the general population of the same geographical area. The standardised incidence ratios (SIRs) for all malignancies and for lung cancer were higher than expected (2.39, 95% CI ¼ 1.6 -3.5, Po0.001; 10.1, 95% CI ¼ 6.2 -15.6, Po0.0001, respectively). The standardised mortality ratio (SMR) was also significantly increased (1.73, 95% CI ¼ 1.1 -2.6, P ¼ 0.013). The excess mortality could be entirely explained by an increase in mortality from lung cancer (5.7, 95% CI ¼ 2.8 -10.1, Po0.0001). This study shows that patients, resected for pathological stage I NSCLC and tumour-free after 5 years, have a higher incidence of new lung cancer compared with the general population, which in turn determines an excess in all-cause mortality in the following years.

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Section: Discussionsupporting

confidence: 60%

Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years

et al. 2003

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“…Almost all of those who were diagnosed with stage I lung cancer as a result of CXR screening and refused treatment died of their disease, as demonstrated by Flehinger et al [58], Yankelevitz et al [67], and Sobue et al [68] in Japan. In the Figure 11.…”

Section: Overdiagnosismentioning

confidence: 95%

“…The ELCAP approach does not have the problems that have been recognized as occurring in randomized trials [14,[51][52][53][54][55][56][57][58][59][60][61]. Biases of randomized trial results include having: (a) an insensitive outcome measure, the cumulative mortality rate, which does not focus on the relevant time when the number of deaths prevented by screening is seen [47,[51][52][53][54][55]; (b) an inadequate number of rounds of screening, so that a decrease in the mortality rate cannot be seen [19,45]; (c) protocol nonadherence [45,51,59,61]; (d) delays in diagnosis and/or treatment or participants choosing not to be treated [58], without any analysis of whether this proportion was the same in both arms of the trial; and (e) reliance on death certificates [60].…”

Section: Advantages Of the Elcap Approachmentioning

confidence: 99%

“…Biases of randomized trial results include having: (a) an insensitive outcome measure, the cumulative mortality rate, which does not focus on the relevant time when the number of deaths prevented by screening is seen [47,[51][52][53][54][55]; (b) an inadequate number of rounds of screening, so that a decrease in the mortality rate cannot be seen [19,45]; (c) protocol nonadherence [45,51,59,61]; (d) delays in diagnosis and/or treatment or participants choosing not to be treated [58], without any analysis of whether this proportion was the same in both arms of the trial; and (e) reliance on death certificates [60]. By the time that randomized screening trials are completed, there may also have been considerable technology drift so that the results are no longer relevant.…”

Section: Advantages Of the Elcap Approachmentioning

confidence: 99%

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CT Screening for Lung Cancer: Update 2007

Henschke

Yankelevitz

2008

The Oncologist

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Screening is the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment.The goal of the Early Lung Cancer Action Project investigators was to develop an efficient methodology that would provide an ever-accumulating, continually updated body of evidence for evaluation of emerging new technologies for screening for cancer. This methodology recognizes that screening is a sequential process that starts with the pursuit of the early diagnosis of cancer followed by early treatment. It also recognizes that diagnostic research is fundamentally different from treatment research. To fully understand the current discussions on the evidence for lung cancer screening, key definitions are provided, including the differentiation between the first, baseline round of screening and all subsequent rounds of repeat screening and baseline and repeat cancers and their distribution by cell type. These definitions are critical in analyzing the results of various screening reports as they are not used by all.To provide optimal screening, a regimen for the diagnostic workup must be specified starting with the definition of the initial test, its positive result, and the workup for a positive result leading to a diagnosis of cancer. Assessment of diagnostic performance does not require a control group, but does require confirmation of the diagnosis.For assessment of the effectiveness of early treatment, a comparison group is needed. The comparison group may be formed by randomly assigning people with screen-diagnosed lung cancer to immediate or delayed treatment, as has been done for prostate cancer. This provides a direct assessment of any potential overdiagnosis of the cancer resulting from screening. Alternatively, a quasiexperimental control group can be used KEY CONCEPTS AND DEFINITIONSScreening has been defined as the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment. To fully understand current discussions on the evidence for lung cancer screening, key concepts of screening and definitions are needed.Screening for a cancer should be considered when the cancer is significant in terms of incidence and mortality, treatment of early-stage disease is better than treatment of late-stage disease, and there is a test that provides an earlier diagnosis-lead time-rather than a later, symptomprompted diagnosis [1,2].Lung cancer kills more people than any other cancer worldwide. In the U.S. it kills more pe...

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“…Arguments against overdiagnosis are: 1) there is no evidence that latent lung cancer is frequently found at autopsy [63,64]; 2) data from seven studies show that untreated patients with stage I early-detected lung cancer do not have a protracted and undisturbed survival. Their 5-yr survival is only 0-10%, while stage I surgically treated patients survive in 70-85% of cases after 5 yrs [61,65,66]; and 3) there is no biological evidence to support the contention that lung cancer sometimes behaves in a benign fashion. However, MCFARLANE et al [67] reported in their epidemiological necropsy study that they had identified a large "reservoir" of undiagnosed lung cancer cases that had neither caused nor contributed to the death of their patients.…”

Section: Biases In Lung Cancer Screeningmentioning

confidence: 99%

Lung cancer screening by low-dose spiral computed tomography

Klaveren

Habbema²,

Pedersen³

et al. 2001

European Respiratory Journal

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The poor prognosis of lung cancer has barely changed in the last decades, but the prognosis is better when the disease is detected earlier. Lung cancer screening by chest radiography did not lead to a decrease in lung cancer mortality, presumably because the chest radiograph is a poor screening tool with low sensitivity.With the advent of the low-dose spiral computed tomography (CT) scan it has become feasible to detect early invasive stage I lung cancer in 80-90% of cases. This technique could possibly decrease lung cancer mortality, but the extent of this effect is as yet unknown, and whether lung cancer screening will be cost-effective is yet to be determined. These questions can only be resolved in a randomized controlled trial with lung cancer mortality as an unbiased end-point.In this review, the initiatives to evaluate low dose spiral CT screening for lung cancer in Japan, USA and Europe are presented. In the USA and Japan, evaluation is in onearmed studies, whereas in many European countries randomized trials are now being planned and several one-armed studies have been initiated. A formal collaboration among these countries has now been set up.It is strongly recommended that lung cancer screening be evaluated in randomized trials in order to allow evidence-based health policy decisions to be made on this subject.

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The Effect of Surgical Treatment on Survival from Early Lung Cancer

Cited by 316 publications

References 8 publications

Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years

Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years

CT Screening for Lung Cancer: Update 2007

Lung cancer screening by low-dose spiral computed tomography

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