Chest
ORIGINAL RESEARCHLUNG CANCERNatural History of Stage I Non-Small Cell Lung Cancer: Implications for Early Detection
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
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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.