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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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