Details

Autor(en) / Beteiligte

• 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

Titel

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

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2014-05, Vol.147 (5), p.1619-1626

Ort / Verlag

United States: Mosby, Inc

Erscheinungsjahr

2014

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.