Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer

Raja Flores, Thomas Bauer, Ralph Aye, Shahriyour Andaz, Leslie Kohman, Barry Sheppard, William Mayfield, Richard J Thurer, Michael Smith, Robert Korst, Michaela Straznicka, Fred Grannis, Harvey Pass, Cliff Connery, Rowena Yip, James P. Smith, David Yankelevitz, Claudia Henschke, Nasser Altorki

Research output: Contribution to journalArticle

30 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1619-1626
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number5
DOIs
StatePublished - Jan 1 2014

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Unnecessary Procedures
Lung Neoplasms
Tomography
Confidence Intervals
Video-Assisted Thoracic Surgery
Carcinoid Tumor
Lung
Survival
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer. / Flores, Raja; Bauer, Thomas; Aye, Ralph; Andaz, Shahriyour; Kohman, Leslie; Sheppard, Barry; Mayfield, William; Thurer, Richard J; Smith, Michael; Korst, Robert; Straznicka, Michaela; Grannis, Fred; Pass, Harvey; Connery, Cliff; Yip, Rowena; Smith, James P.; Yankelevitz, David; Henschke, Claudia; Altorki, Nasser.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 5, 01.01.2014, p. 1619-1626.

Research output: Contribution to journalArticle

Flores, R, Bauer, T, Aye, R, Andaz, S, Kohman, L, Sheppard, B, Mayfield, W, Thurer, RJ, Smith, M, Korst, R, Straznicka, M, Grannis, F, Pass, H, Connery, C, Yip, R, Smith, JP, Yankelevitz, D, Henschke, C & Altorki, N 2014, 'Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer', Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 5, pp. 1619-1626. https://doi.org/10.1016/j.jtcvs.2013.11.001
Flores, Raja ; Bauer, Thomas ; Aye, Ralph ; Andaz, Shahriyour ; Kohman, Leslie ; Sheppard, Barry ; Mayfield, William ; Thurer, Richard J ; Smith, Michael ; Korst, Robert ; Straznicka, Michaela ; Grannis, Fred ; Pass, Harvey ; Connery, Cliff ; Yip, Rowena ; Smith, James P. ; Yankelevitz, David ; Henschke, Claudia ; Altorki, Nasser. / Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 5. pp. 1619-1626.
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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.",
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AU - Flores, Raja

AU - Bauer, Thomas

AU - Aye, Ralph

AU - Andaz, Shahriyour

AU - Kohman, Leslie

AU - Sheppard, Barry

AU - Mayfield, William

AU - Thurer, Richard J

AU - Smith, Michael

AU - Korst, Robert

AU - Straznicka, Michaela

AU - Grannis, Fred

AU - Pass, Harvey

AU - Connery, Cliff

AU - Yip, Rowena

AU - Smith, James P.

AU - Yankelevitz, David

AU - Henschke, Claudia

AU - Altorki, Nasser

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N2 - 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.

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