Advertisement

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
      This paper is only available as a PDF. To read, Please Download here.

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Thoracic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect