Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer
Objective Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). Methods We identified all patients who underwent surgica...
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| creator | Flores, Raja, MD Bauer, Thomas, MD Aye, Ralph, MD Andaz, Shahriyour, MD Kohman, Leslie, MD Sheppard, Barry, MD Mayfield, William, MD Thurer, Richard, MD Smith, Michael, MD Korst, Robert, MD Straznicka, Michaela, MD Grannis, Fred, MD Pass, Harvey, MD Connery, Cliff, MD Yip, Rowena, MPH Smith, James P., MD Yankelevitz, David, MD Henschke, Claudia, PhD, MD Altorki, Nasser, MD |
| description | Objective Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). Methods We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. Results Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% ( P |
| doi_str_mv | 10.1016/j.jtcvs.2013.11.001 |
| format | Article |
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We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). Methods We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. Results Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% ( P < .0001) and 22% to 34% ( P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size ( P = .61), or cell type ( P = .81). Conclusions The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.11.001</identifier><identifier>PMID: 24332102</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Cardiothoracic Surgery ; Early Detection of Cancer ; Early Medical Intervention ; Female ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms - diagnostic imaging ; Lung Neoplasms - mortality ; Lung Neoplasms - surgery ; Male ; Mass Screening - methods ; Middle Aged ; Neoplasm Staging ; Patient Selection ; Pneumonectomy - methods ; Predictive Value of Tests ; Prognosis ; Thoracic Surgery, Video-Assisted ; Time Factors ; Tomography, X-Ray Computed ; United States ; Unnecessary Procedures</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-05, Vol.147 (5), p.1619-1626</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-31b70ce2ce3fb50ac8649eb0b86a801e5709be55d9e6fc9d3e80ee39a54a14643</citedby><cites>FETCH-LOGICAL-c525t-31b70ce2ce3fb50ac8649eb0b86a801e5709be55d9e6fc9d3e80ee39a54a14643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522313012920$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24332102$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Flores, Raja, MD</creatorcontrib><creatorcontrib>Bauer, Thomas, MD</creatorcontrib><creatorcontrib>Aye, Ralph, MD</creatorcontrib><creatorcontrib>Andaz, Shahriyour, MD</creatorcontrib><creatorcontrib>Kohman, Leslie, MD</creatorcontrib><creatorcontrib>Sheppard, Barry, MD</creatorcontrib><creatorcontrib>Mayfield, William, MD</creatorcontrib><creatorcontrib>Thurer, Richard, MD</creatorcontrib><creatorcontrib>Smith, Michael, MD</creatorcontrib><creatorcontrib>Korst, Robert, MD</creatorcontrib><creatorcontrib>Straznicka, Michaela, MD</creatorcontrib><creatorcontrib>Grannis, Fred, MD</creatorcontrib><creatorcontrib>Pass, Harvey, MD</creatorcontrib><creatorcontrib>Connery, Cliff, MD</creatorcontrib><creatorcontrib>Yip, Rowena, MPH</creatorcontrib><creatorcontrib>Smith, James P., MD</creatorcontrib><creatorcontrib>Yankelevitz, David, MD</creatorcontrib><creatorcontrib>Henschke, Claudia, PhD, MD</creatorcontrib><creatorcontrib>Altorki, Nasser, MD</creatorcontrib><creatorcontrib>I-ELCAP Investigators</creatorcontrib><title>Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). Methods We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. Results Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% ( P < .0001) and 22% to 34% ( P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size ( P = .61), or cell type ( P = .81). Conclusions The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.</description><subject>Aged</subject><subject>Cardiothoracic Surgery</subject><subject>Early Detection of Cancer</subject><subject>Early Medical Intervention</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung Neoplasms - diagnostic imaging</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Patient Selection</subject><subject>Pneumonectomy - methods</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Thoracic Surgery, Video-Assisted</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>United States</subject><subject>Unnecessary Procedures</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9u1DAQxi0EotvCEyChHLkkzNhxNjmABBUUpEocAImb5TiTrZfEXmynYt-GZ-HJcNjCgQunuXx_9P2GsScIFQI2z_fVPpnbWHFAUSFWAHiPbRC6bdm08st9tgHgvJScizN2HuMeALaA3UN2xmshOALfsPm1nrQz1u0KswTd28mmY6HdUCzOkaEYdTgWcQk7yte6It1QYbxL9D0Vfvz5w_j5sCQaiuRnvwv6cJPlJhC5NXP0oZiWNTyXUHjEHox6ivT47l6wz2_ffLp8V15_uHp_-eq6NJLLVArst2CIGxJjL0Gbtqk76qFvG90CktxC15OUQ0fNaLpBUAtEotOy1lg3tbhgz065h-C_LRSTmm00NOWp5JeoUHIUNdRtl6XiJDXBxxhoVIdg5zxaIaiVs9qr35zVylkhqsw5u57eFSz9TMNfzx-wWfDiJKA889ZSUNFYygwGG8gkNXj7n4KX__jNZJ01evpKR4p7vwSXCSpUkStQH9dXr59GAcg7DuIX0l-nkg</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Flores, Raja, MD</creator><creator>Bauer, Thomas, MD</creator><creator>Aye, Ralph, MD</creator><creator>Andaz, Shahriyour, MD</creator><creator>Kohman, Leslie, MD</creator><creator>Sheppard, Barry, MD</creator><creator>Mayfield, William, MD</creator><creator>Thurer, Richard, MD</creator><creator>Smith, Michael, MD</creator><creator>Korst, Robert, MD</creator><creator>Straznicka, Michaela, MD</creator><creator>Grannis, Fred, MD</creator><creator>Pass, Harvey, MD</creator><creator>Connery, Cliff, MD</creator><creator>Yip, Rowena, MPH</creator><creator>Smith, James P., MD</creator><creator>Yankelevitz, David, MD</creator><creator>Henschke, Claudia, PhD, MD</creator><creator>Altorki, Nasser, MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer</title><author>Flores, Raja, MD ; Bauer, Thomas, MD ; Aye, Ralph, MD ; Andaz, Shahriyour, MD ; Kohman, Leslie, MD ; Sheppard, Barry, MD ; Mayfield, William, MD ; Thurer, Richard, MD ; Smith, Michael, MD ; Korst, Robert, MD ; Straznicka, Michaela, MD ; Grannis, Fred, MD ; Pass, Harvey, MD ; Connery, Cliff, MD ; Yip, Rowena, MPH ; Smith, James P., MD ; Yankelevitz, David, MD ; Henschke, Claudia, PhD, MD ; Altorki, Nasser, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-31b70ce2ce3fb50ac8649eb0b86a801e5709be55d9e6fc9d3e80ee39a54a14643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Cardiothoracic Surgery</topic><topic>Early Detection of Cancer</topic><topic>Early Medical Intervention</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lung Neoplasms - diagnostic imaging</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Patient Selection</topic><topic>Pneumonectomy - methods</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Thoracic Surgery, Video-Assisted</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>United States</topic><topic>Unnecessary Procedures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Flores, Raja, MD</creatorcontrib><creatorcontrib>Bauer, Thomas, MD</creatorcontrib><creatorcontrib>Aye, Ralph, MD</creatorcontrib><creatorcontrib>Andaz, Shahriyour, MD</creatorcontrib><creatorcontrib>Kohman, Leslie, MD</creatorcontrib><creatorcontrib>Sheppard, Barry, MD</creatorcontrib><creatorcontrib>Mayfield, William, MD</creatorcontrib><creatorcontrib>Thurer, Richard, MD</creatorcontrib><creatorcontrib>Smith, Michael, MD</creatorcontrib><creatorcontrib>Korst, Robert, MD</creatorcontrib><creatorcontrib>Straznicka, Michaela, MD</creatorcontrib><creatorcontrib>Grannis, Fred, MD</creatorcontrib><creatorcontrib>Pass, Harvey, MD</creatorcontrib><creatorcontrib>Connery, Cliff, MD</creatorcontrib><creatorcontrib>Yip, Rowena, MPH</creatorcontrib><creatorcontrib>Smith, James P., MD</creatorcontrib><creatorcontrib>Yankelevitz, David, MD</creatorcontrib><creatorcontrib>Henschke, Claudia, PhD, MD</creatorcontrib><creatorcontrib>Altorki, Nasser, MD</creatorcontrib><creatorcontrib>I-ELCAP Investigators</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Flores, Raja, MD</au><au>Bauer, Thomas, MD</au><au>Aye, Ralph, MD</au><au>Andaz, Shahriyour, MD</au><au>Kohman, Leslie, MD</au><au>Sheppard, Barry, MD</au><au>Mayfield, William, MD</au><au>Thurer, Richard, MD</au><au>Smith, Michael, MD</au><au>Korst, Robert, MD</au><au>Straznicka, Michaela, MD</au><au>Grannis, Fred, MD</au><au>Pass, Harvey, MD</au><au>Connery, Cliff, MD</au><au>Yip, Rowena, MPH</au><au>Smith, James P., MD</au><au>Yankelevitz, David, MD</au><au>Henschke, Claudia, PhD, MD</au><au>Altorki, Nasser, MD</au><aucorp>I-ELCAP Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>147</volume><issue>5</issue><spage>1619</spage><epage>1626</epage><pages>1619-1626</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objective Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). Methods We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. Results Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% ( P < .0001) and 22% to 34% ( P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size ( P = .61), or cell type ( P = .81). Conclusions The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24332102</pmid><doi>10.1016/j.jtcvs.2013.11.001</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cardiothoracic Surgery Early Detection of Cancer Early Medical Intervention Female Humans Kaplan-Meier Estimate Lung Neoplasms - diagnostic imaging Lung Neoplasms - mortality Lung Neoplasms - surgery Male Mass Screening - methods Middle Aged Neoplasm Staging Patient Selection Pneumonectomy - methods Predictive Value of Tests Prognosis Thoracic Surgery, Video-Assisted Time Factors Tomography, X-Ray Computed United States Unnecessary Procedures |
| title | Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer |
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