Outcomes of resected lung cancer diagnosed through screening and incidental pulmonary nodule programs in a Mississippi Delta cohort.
JTO Clinical and Research Reports(2024)
摘要
Introduction
Early lung cancer detection programs improve surgical resection rates and survival, but may skew towards more indolent cancers.
Methods
Hypothesizing that differences in stage-stratified survival indicate differences in biologic aggressiveness and possible length-time and over-diagnosis bias, we assessed a cohort undergoing curative-intent resection, categorized by diagnostic pathways: screening, incidental pulmonary nodule program, and non-program-based. Survival was analyzed using Kaplan-Meier plots, log-rank tests, and Cox regression, comparing aggregate and stage-stratified survival across cohorts with Tukey’s method for multiple testing.
Results
Of 1588 patients, 111 (7%), 357 (22.5%), and 1120 (70.5%) were diagnosed through screening, pulmonary nodule and non-program-based pathways; 0% v 9% v 6% were >80 years old (p=0.0048); 17%, 23% and 24% had a Charlson Co-morbidity Score ≥2 (p=0.0143); 7%, 6% and 9% had lepidic adenocarcinoma; 26%, 31% and 34% had poorly or undifferentiated tumors (p=0.1544); 93%, 87% and 77% had clinical stage I (p<.0001).Aggregate 5-year survival was 87%, 72%, and 65% (p=0.0009), including 95%, 74%, and 74% for pathologic stage I. Adjusted pairwise comparisons showed similar survival between screening and nodule program cohorts (p=0.9905). However, differences were significant between screening and non-program-based cohorts (p=0.0007, adjusted hazard ratio (aHR) 0.33 [95% CI: 0.18–0.6]) and nodule versus non-program cohorts (aHR 0.78 [95% CI: 0.61–0.99]). Stage I comparisons yielded p=0.2256, 0.1131, and 0.911. In respective pathways, 0%, 2%, and 2% of stage I patients >80 years had a Charlson score ≥2 (p=0.3849).
Conclusions
Neither length-time, nor over-diagnosis bias was evident in NSCLC diagnosed through screening or incidental pulmonary nodule programs.
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关键词
Length-time bias,overdiagnosis bias,early detection,survival
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