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Journal of Thoracic Oncology
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Original Article|Articles in Press

Impact of Duration of Diagnostic Workup on Prognosis for Early Lung Cancer

Published:January 12, 2023DOI:https://doi.org/10.1016/j.jtho.2022.12.020
Impact of Duration of Diagnostic Workup on Prognosis for Early Lung Cancer
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      Abstract

      Introduction

      Growth assessment for pulmonary nodules is an important diagnostic tool, however, the impact on prognosis due to time delay for follow-up diagnostic scans needs to be considered.

      Methods

      Using the data between 2003 and 2019 from the International Early Lung Cancer Action Program (I-ELCAP), a prospective cohort study, we determined the size specific 10-year Kaplan-Meier lung cancer (LC) survival rates as surrogates for cure rates. We estimated the change in LC diameter after delays of 90-, 180-, and 365-days using three representative LC volume doubling times (VDTs) of 60(fast), 120(moderate), and 240(slow). We then estimated the decrease in the lung cancer (LC) cure rate resulting from time between CT scans to assess for growth during the diagnostic workup.

      Results

      Using a regression model of the 10-year LC survival rates on LC diameter, the estimated LC cure rate of a 4.0 mm LC with fast (60-day) VDT is 96.0%(95% CI: 95.2%-96.7%) initially, but it would decrease to 94.3%(95% CI: 93.2%-95.%), 92.0%(95% CI: 90.5%-93.4%) and 83.6%(95% CI: 80.6%-86.6%) after delays of 90, 180, and 365 days, respectively. A 20.0 mm LC with the same VDTs has an initial lower LC cure rate of 79.9%(95% CI: 76.2%-83.5%) initially, and decreases more rapidly to 71.5%(95% CI: 66.4%-76.7%), 59.8%(95%CI:52.4%-67.1%) and 17.9%(95% CI: 3.0%-32.8%) after the same delays of 90, 180, and 365 days.

      Conclusions

      Time between scans required to measure growth of lung nodules impacts prognosis with the effect being greater for fast-growing and larger cancers. Quantifying the extent of change in prognosis is required to understand efficiencies of different management protocols.

      Keywords

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      Article info

      Publication history

      Accepted: December 20, 2022
      Received in revised form: November 18, 2022
      Received: July 15, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      CRediT author statement

      Rowena Yip: Conceptualization, Methodology, Formal analysis, Data Curation, Writing-Original Draft, Writing-Review&Editing

      David F. Yankelevitz: Conceptualization, Methodology, Formal analysis, Writing-Original Draft, Writing-Review&Editing, Supervision

      Claudia I. Henschke: Conceptualization, Methodology, Formal analysis, Writing-Original Draft, Writing-Review&Editing, Supervision

      Funding: This study was sponsored in part by the Simons Foundation International, Ltd.

      Potential Conflicts of Interest:

      Dr. David Yankelevitz is a named inventor on a number of patents and patent applications related to the evaluation of chest diseases including measurements of chest nodules. Dr. Yankelevitz has received financial compensation for the licensing of these patents. In addition, he is a consultant and co-owner of Accumetra, a private company developing tools to improve the quality of CT imaging. He is on the advisory board and owns equity in HeartLung a company that develops software related to CT scans of the chest. He is on the medical advisory board of Median Technology that is developing technology related to analyzing pulmonary nodules and is on the medical advisory board of Carestream, a company that develops radiography equipment and has consulted for Genentech, AstraZeneca and Pfizer.

      Dr. Henschke is also an inventor of the patents and pending patents owned by Cornell Research

      Foundation (CRF). As of April 2009, she has divested herself of all royalties and other interests arising from these.

      Others: None

      Identification

      DOI: https://doi.org/10.1016/j.jtho.2022.12.020

      Copyright

      © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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