Chest
Volume 132, Issue 1, July 2007, Pages 193-199
Journal home page for Chest

ORIGINAL RESEARCH
LUNG CANCER
Natural History of Stage I Non-Small Cell Lung Cancer: Implications for Early Detection

https://doi.org/10.1378/chest.06-3096Get rights and content

Background:

Concern has been raised that early detection of lung cancer may lead to the treatment of clinically indolent cancers. No population-based study has examined the natural history of patients with stage I NSCLC who receive no surgery, chemotherapy, or radiation therapy. Our hypothesis is that long-term survival in patients with untreated stage I non-small cell lung cancer (NSCLC) is uncommon.

Methods:

A total of 101,844 incident cases of NSCLC in the California Cancer Center registry between 1989 and 2003 were analyzed; 19,702 patients had stage I disease, of whom 1,432 did not undergo surgical resection or receive treatment with chemotherapy or radiation. Five-year overall survival (OS) and lung cancer-specific survival were determined for this untreated group, for subsets of patients who were recommended but refused surgical resection, and for T1 tumors.

Results:

Only 42 patients with untreated stage I NSCLC were alive 5 years after diagnosis. Five-year OS for untreated stage I NSCLC was 6% overall, 9% for T1 tumors, and 11% for patients who refused surgical resection. Five-year lung cancer-specific survival rates were 16%, 23%, and 22%, respectively. Among these untreated patients, median survival was 9 months overall, 13 months for patients with T1 disease, and 14 months for patients who refused surgical resection.

Conclusion:

Long-term survival with untreated stage I NSCLC is uncommon, and the vast majority of untreated patients die of lung cancer. Given that median survival is only 13 months in patients with T1 disease, surgical resection or other ablative therapies should not be delayed even in patients with small lung cancers.

Section snippets

Materials and Methods

Data were obtained on 101,844 incident non-small cell lung cancer (NSCLC) cases in the CCR during the period from 1989 to 2003 with TNM staging data and complete follow-up data available. This included 19,702 stage I, 3,753 stage II, 10,429 stage IIIA, 22,285 stage IIIB, and 45,675 stage IV NSCLC patients. Recorded data included demographic information (age, gender, ethnicity), stage at presentation, histology, tumor size, tumor location, socioeconomic status, and vital status. Socioeconomic

Results

Information related to surgical treatment rendered on the primary tumor was available for 19,699 of the 19,702 stage I NSCLC patients (99.9%), among whom 16,184 (82%) underwent surgical resection (median overall survival [OS], 69 months; 95% confidence interval [CI], 67 to 71; 5-year OS, 54%). Of the remaining 3,515 patients, 1,432 patients (41%) did not receive chemotherapy or radiation therapy (Fig 1). Median overall survival among these untreated stage I NSCLC patients was 9 months (95% CI,

Discussion

Our results show that long-term survival with untreated stage I NSCLC is uncommon. The estimated 5-year survival of all untreated stage I patients in California during the study period was 7%, with a median survival of only 9 months. While many untreated patients did not undergo treatment due to underlying medical comorbidities, an estimated 89% of patients who were recommended to undergo surgical treatment but refused died within 5 years, with 78% of those patients dying of lung cancer.

Among

References (28)

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This work was supported by the UCSF Department of Surgery (salary support for D.R.) and the Larry Hall Memorial Trust (salary support for D.J.). Dr. Jablons has received honoraria from Genentech and Eli Lily Pharmaceuticals over the past 5 years. There are no other potential conflicts of interest to disclose for the other authors.

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