Difference in tumor size in early-stage (Stage IA) lung cancer is predictive of differences in survival
Difference in tumor size is an important predictor
of survival even in patients with early-stage lung cancer (Stage
IA, nonmetastasized disease, tumors less than 3 cm in size), according
to an article in the November issue of CHEST.
The American study showed that patients with
lung tumors less than 2 cm in size had a higher 5-year survival
rate than patients with tumors that were 2 to 3 cm in size. The
authors suggest that this difference within a single clinical stage
(Stage IA, less than 3 cm tumor size) indicates that further substaging
may be needed to accurately assess and treat the disease.
“Although previous studies have noted a distinct
difference in survival between patients with nonmetastasized tumors
less than 3 cm [Stage IA] and tumors more than 3 cm in size [Stage
IB], little information is available on whether size remains an
important determinant of survival in tumors less than 3 cm,” said
Jeffrey L. Port, MD, lead author of the study. “Our study indicates
that within Stage IA, a tumor size difference of even 1 cm can impact
survival, leading us to believe that further substaging of Stage
IA lung cancer is necessary to ensure patients in this stage are
receiving the most effective treatment.”
The researchers evaluated the relationship
between tumor size and 5-year survival in 244 people with Stage
IA non-small cell lung cancer who underwent surgical resection for
lung tumors. Overall mortality and survival rates and cancer-specific
mortality and survival rates were analyzed and compared with tumor
size. The overall 5-year survival rate in patients was 71.1 percent
compared with an overall 5-year disease-specific survival rate of
74.9 percent. In terms of tumor size, disease-specific survival
was 81.4 percent for patients with tumors less than or equal to
2 cm and 63.4 percent for patients with tumors greater than 2 cm
but less than 3 cm.
“Lung cancer is most curable when it is detected
early. However, by the time most people are diagnosed with lung
cancer, they have surpassed the curable stages of the disease,”
said Port. “Improved survival in patients with stage I lung cancer
has rekindled interest in lung cancer screening for the purpose
of detecting smaller and potentially more curable lesions. Our findings
suggest that lung cancer screenings may be useful in discovering
even the smallest of lesions that can, in turn, represent early-stage
lung disease.”
“Although further substaging of early-stage
lung tumors may be necessary to accurately assess and treat patients
with lung cancer, routine CT screening for the detection of lung
cancer is controversial,” said Richard S. Irwin, MD, President of
the American College of Chest Physicians. “This study reinforces
the need for further investigation into the benefits and outcomes
associated with lung cancer screening.”
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