Computed Tomography Screening for Lung Cancer

Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

Writing committee for the I-ELCAP Investigators

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVE:: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND:: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS:: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS:: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4–3.8), centrally located tumor (HR 2.5, 95% CI 1.2–5.2), tumor size 21 to 30?mm (HR 2.7, 95% CI 1.2–6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4–6.1). For the 346 patients with MLNR, tumor size was 20?mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS:: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - May 26 2016

Fingerprint

Non-Small Cell Lung Carcinoma
Lung Neoplasms
Lymph Nodes
Tomography
Confidence Intervals
Survival Rate
Neoplasms
Research Ethics Committees
Regression Analysis
Demography
Lung
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Computed Tomography Screening for Lung Cancer : Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules. / Writing committee for the I-ELCAP Investigators.

In: Annals of Surgery, 26.05.2016.

Research output: Contribution to journalArticle

@article{fa800cac32b84adcb0f13906ca758052,
title = "Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules",
abstract = "OBJECTIVE:: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND:: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS:: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS:: The long-term K-M rates for 462 with and 145 without MLNR was 92{\%} versus 96{\%} (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100{\%}. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87{\%} versus 94{\%} (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95{\%} confidence interval [CI] 1.4–3.8), centrally located tumor (HR 2.5, 95{\%} CI 1.2–5.2), tumor size 21 to 30?mm (HR 2.7, 95{\%} CI 1.2–6.0), and invasion beyond the lung stroma (HR 3.0, 95{\%} CI 1.4–6.1). For the 346 patients with MLNR, tumor size was 20?mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS:: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.",
author = "{Writing committee for the I-ELCAP Investigators} and Flores, {Raja M.} and Daniel Nicastri and Thomas Bauer and Ralph Aye and Shahriyour Andaz and Leslie Kohman and Barry Sheppard and William Mayfield and Thurer, {Richard J} and Robert Korst and Michaela Straznicka and Fred Grannis and Harvey Pass and Cliff Connery and Rowena Yip and Smith, {James P.} and Yankelevitz, {David F.} and Henschke, {Claudia I.} and Altorki, {Nasser K.}",
year = "2016",
month = "5",
day = "26",
doi = "10.1097/SLA.0000000000001802",
language = "English (US)",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Computed Tomography Screening for Lung Cancer

T2 - Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

AU - Writing committee for the I-ELCAP Investigators

AU - Flores, Raja M.

AU - Nicastri, Daniel

AU - Bauer, Thomas

AU - Aye, Ralph

AU - Andaz, Shahriyour

AU - Kohman, Leslie

AU - Sheppard, Barry

AU - Mayfield, William

AU - Thurer, Richard J

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 F.

AU - Henschke, Claudia I.

AU - Altorki, Nasser K.

PY - 2016/5/26

Y1 - 2016/5/26

N2 - OBJECTIVE:: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND:: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS:: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS:: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4–3.8), centrally located tumor (HR 2.5, 95% CI 1.2–5.2), tumor size 21 to 30?mm (HR 2.7, 95% CI 1.2–6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4–6.1). For the 346 patients with MLNR, tumor size was 20?mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS:: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

AB - OBJECTIVE:: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND:: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS:: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS:: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4–3.8), centrally located tumor (HR 2.5, 95% CI 1.2–5.2), tumor size 21 to 30?mm (HR 2.7, 95% CI 1.2–6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4–6.1). For the 346 patients with MLNR, tumor size was 20?mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS:: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

UR - http://www.scopus.com/inward/record.url?scp=84970027861&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84970027861&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001802

DO - 10.1097/SLA.0000000000001802

M3 - Article

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -