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.
Abbreviations and Acronyms
CI
confidence interval
CT
computed tomography
I-ELCAP
International Early Lung Cancer Action Program
NLST
National Lung Screening Trial
PET
positron emission tomography
VATS
video-assisted thoracoscopic surgery
CTSNet classification
10
10.4
Cited by (0)
Disclosures: David Yankelevitz is a named inventor on several patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules. Some of these, which are owned by Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric. As an inventor of these patents, Dr Yankelevitz is entitled to a share of any compensation that CRF may receive from its commercialization of these patents. Claudia Henschke is also an inventor of the patents and pending patents owned by CRF. Since April 2009, she has divested herself of all royalties and other interests arising from these. Fred Grannis has provided paid written expert witness and oral deposition testimony in 3 state medical monitoring lawsuits against Philip Morris Corporation between 2007 and the present date. All other authors have nothing to disclose with regard to commercial support.
The I-ELCAP Investigators are listed in Appendix 1.
