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Shaikh T, Churilla TM, Murphy CT, Zaorsky NG, Haber A, Hallman MA, Meyer JE
Absence of pathological proof of cancer associated with improved outcomes in early stage lung cancer
J Thorac Oncol (2016) 11:1112-20.
BACKGROUND: The purpose of this study was to assess the trends in clinical diagnosis use and its impact on treatment outcomes in patients receiving radiation therapy for early stage lung cancer. METHODS: The Surveillance, Epidemiology, and End Results registry was queried from 2004-2012 for patients >18 years old diagnosed with Stage I (clinical T1a-T2a) lung cancer who underwent radiation therapy alone. Trends in diagnostic confirmation patterns were characterized. Cox proportional hazards model was used to assess overall survival (OS), competing risk regression analysis was used to assess cancer specific survival (CSS). RESULTS: A total of 7,050 patients were included; 6,399 (90.8%) were pathologically diagnosed and 651 (9.2%) were clinical diagnosed. There was no significant change in the utilization of clinical versus pathologic diagnosis (p=0.172) over time. Patients with T1 disease (p<0.001), tumors 0-1.9 cm in size (p<0.001), and upper lobe tumors (p=0.004) were more likely to be clinically diagnosed. On multivariable analysis, clinical diagnosis was associated with an improved CSS (HR 0.82 95% CI 0.71-0.96) but was not associated with an improved OS (HR 1.01 95% CI 0.90-1.13). When stratifying by T-stage, clinically diagnosed T1a patients had an improved CSS (HR 0.75 95% CI 0.58-0.96 p=0.022). There was a trend towards improved CSS in patients with clinical T1b tumors (HR 0.74 95% CI 0.55-1.00 p=0.052). CONCLUSION(S): The improved CSS in clinically diagnosed patients suggests treatment of benign disease particularly in smaller tumors. Prudent patient selection is needed to reduce the potential for overtreatment.
Publication Date: 2016-07-01.
Last updated on Sunday, August 09, 2020