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Early-stage lung cancer patients risk treatment of benign disease

Researchers in a recent study recommended improvements in patient selection to help reduce the overtreatment of lung cancer patients with benign disease, according to recently presented data at the European Lung Cancer Conference in Geneva, Switzerland.

“The main finding of our study is the improved cancer-specific survival in patients undergoing clinical versus pathologic diagnosis for Stage I lung cancer without any difference in overall survival,” Talha Shaikh, MD, from the department of radiation oncology at Fox Chase Cancer Center in Philadelphia, said in a press release. “We hypothesize that the disparity in cancer-specific survival between patients diagnosed clinically versus pathologically may be due to a greater number of patients in the clinical diagnosis arm having benign disease, which precludes them from developing a cancer-related death.”

Shaikh and colleagues analyzed data in the Surveillance, Epidemiology and End Results (SEER) registry over an 8-year period from 7,050 patients who were minimum 18 years old and received radiation therapy for stage 1 clinical T1a and T2a lung cancer. Using a Cox proportional hazards model, they determined the cancer-specific survival of patients by diagnosis and treatment with radiation therapy.

The researchers found 6,399 patients received a pathological diagnosis (90.8%) and 651 patients received a clinical diagnosis (9.2%), with patients diagnosed clinically showing greater cancer-specific survival according to a multivariable analysis (HR = 0.82; 95% CI, 0.71-0.96). Specifically, there was improved cancer-specific survival in patients with clinically diagnosed patients with stage 1 T1a patients (HR = 0.75; 95% CI, 0.58-0.96; P = 0.022) and a trend of improving cancer-specific survival in stage 1 T1b patients (HR-0.74; 95% CI, 0.55-1.00; P = 0.052).

While there were significant differences between cancer-specific survival and mode of diagnosis, Shaikh and colleagues noted there no significant change regarding the diagnostic methods used over the 8-year study period (P = 0.172).

Cancer-specific survival outcomes based on interval quartile tumor size showed improved survival for patients with tumors between 0 and 1.9 cm (HR = 0.74; 95% CI, 0.58-0.99; P = 0.040) with a trend of improving cancer-specific survival in tumors at 2.0 cm to 2.7 cm (HR = 0.78; 95% CI, 0.58-1.03; P = 0.083). Overall survival was not associated with clinically diagnosed early stage lung cancer (HR = 1.01; 95% CI, 0.90-1.13). – by Jeff Craven

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