Raja Flores1, Thomas Bauer2, Ralph Aye3, Shahriyour Andaz4, Leslie Kohman5, Barry Sheppard6, William Mayfield7, Richard Thurer8, Michael Smith9, Robert Korst10, Michaela Straznicka11, Fred Grannis12, Harvey Pass13, Cliff Connery1, Rowena Yip1, James P Smith14, David Yankelevitz1, Claudia Henschke15, Nasser Altorki16. 1. Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY. 2. Department of Surgery, Christiana Care, Helen F. Graham Cancer Center, Newark, Del. 3. Department of Surgery, Swedish Medical Center, Seattle, Wash. 4. Department of Surgery, South Nassau Communities Hospital, Long Island, NY. 5. Department of Surgery, Upstate Medical Center, Syracuse, NY. 6. Department of Surgery, Mills-Peninsula Health Services, San Mateo, Calif. 7. Department of Surgery, Wellstar Health System, Marietta, Ga. 8. Department of Surgery, Jackson Memorial Hospital, University of Miami, Miami, Fla. 9. Department of Surgery, Georgia Institute for Lung Cancer Research, Atlanta, Ga. 10. Department of Surgery, The Valley Hospital Cancer Center, Paramus, NJ. 11. Department of Surgery, John Muir Cancer Institute, Concord, Calif. 12. Department of Surgery, City of Hope National Medical Center, Duarte, Calif. 13. Department of Surgery, New York University Medical Center, New York, NY. 14. Department of Medicine, Weill Cornell Medical College, New York, NY. 15. Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY. Electronic address: claudia.henschke@mountsinai.org. 16. Department of Cardiovascular Surgery, Weill Cornell Medical College, New York, NY.
Abstract
OBJECTIVE: Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). METHODS: We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. RESULTS: Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% (P < .0001) and 22% to 34% (P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size (P = .61), or cell type (P = .81). CONCLUSIONS: The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.
OBJECTIVE: Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). METHODS: We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. RESULTS: Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% (P < .0001) and 22% to 34% (P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size (P = .61), or cell type (P = .81). CONCLUSIONS: The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.
Authors: Leslie J Kohman; Lin Gu; Nasser Altorki; Ernest Scalzetti; Linda J Veit; Jason M Wallen; Xiaofei Wang Journal: J Thorac Cardiovasc Surg Date: 2017-02-07 Impact factor: 5.209
Authors: David F Yankelevitz; Rowena Yip; James P Smith; Mingzhu Liang; Ying Liu; Dong Ming Xu; Mary M Salvatore; Andrea S Wolf; Raja M Flores; Claudia I Henschke Journal: Radiology Date: 2015-06-23 Impact factor: 11.105
Authors: Raja M Flores; Daniel Nicastri; Thomas Bauer; Ralph Aye; Shahriyour Andaz; Leslie Kohman; Barry Sheppard; William Mayfield; Richard Thurer; Robert Korst; Michaela Straznicka; Fred Grannis; Harvey Pass; Cliff Connery; Rowena Yip; James P Smith; David F Yankelevitz; Claudia I Henschke; Nasser K Altorki Journal: Ann Surg Date: 2017-05 Impact factor: 12.969