Absence of Pathological Proof of Cancer Associated with Improved Outcomes in Early-Stage Lung Cancer.
OBJECTIVES: The purpose of this study was to assess the trends in use of clinical diagnosis and its impact on treatment outcomes in patients receiving radiation therapy for early-stage lung cancer.
METHODS: The Surveillance, Epidemiology, and End Results registry was queried from 2004 to 2012 for patients at least 18 years old in whom stage I (clinical stage T1a-T2a) lung cancer had been diagnosed and who underwent radiation therapy alone. Trends in diagnostic confirmation patterns were characterized. A Cox proportional hazards model was used to assess overall survival, and competing risk regression analysis was used to assess cancer-specific survival (CSS).
RESULTS: A total of 7050 patients were included; the disease of 6399 of them (90.8%) was pathologically diagnosed and that of 651 (9.2%) was clinically diagnosed. There was no significant change in the utilization of clinical versus pathologic diagnosis (p = 0.172) over time. Patients with T1 disease (p < 0.001), tumors 0 to 1.9 cm in size (p < 0.001), and upper lobe tumors (p = 0.004) were more likely to have been clinically diagnosed. On multivariable analysis, clinical diagnosis was associated with an improved CSS (hazard ratio [HR] = 0.82, 95% confidence interval [CI]: 0.71-0.96) but was not associated with an improved overall survival (HR = 1.01, 95% CI: 0.90-1.13). When stratified by T stage, patients whose disease had been clinically diagnosed as stage T1a had an improved CSS (HR = 0.75, 95% CI: 0.58-0.96, p = 0.022). There was a trend toward improved CSS in patients with clinical stage T1b tumors (HR = 0.74, 95% CI: 0.55-1.00, p = 0.052).
CONCLUSIONS: The improved CSS in patients with a clinical diagnosis suggests treatment of benign disease, particularly in smaller tumors. Prudent patient selection is needed to reduce the potential for overtreatment.
Published In/Presented At
Shaikh, T., Churilla, T. M., Murphy, C. T., Zaorsky, N. G., Haber, A., Hallman, M. A., & Meyer, J. E. (2016). Absence of Pathological Proof of Cancer Associated with Improved Outcomes in Early-Stage Lung Cancer. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 11(7), 1112–1120. https://doi.org/10.1016/j.jtho.2016.03.024
Medicine and Health Sciences | Oncology
Department of Radiation Oncology