The Effect of Surgical Treatment on Survival from Early Lung Cancer: Implications for Screening

doi:10.1378/chest.101.4.1013

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Volume 101, Issue 4, April 1992, Pages 1013-1018

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We assessed the effect of surgery on survival from stage I non-small-cell lung cancer based on data collected in these screening programs. The majority of patients diagnosed in each program were treated by surgical resection, but 5 percent of the Sloan-Kettering group, 21 percent of the Hopkins group and 11 percent of the Mayo group failed to receive surgical treatment. Appoximately 70 percent of the stage I patients in each program who were treated surgically survived more than five years, but there were only two five-year survivors among those who did not have surgery. We conclude that patients with lung cancers detected in stage I by chest x-ray film and treated surgically have a good chance of remaining free of disease for many years. Those stage I lung cancers which are not resected progress and lead to death within five years. Therefore, every effort should be made to detect and treat lung cancer early in high-risk populations.

Section snippets

BACKGROUND AND METHODS

By direct access to the computer-based files of the Mayo, Hopkins and Sloan-Kettering early lung cancer detection studies, we identified all cases of stage I (T1N0M0, T2N0M0)⁹ non-small-cell lung cancer diagnosed in the years 1974 to 1984 in the populations enrolled in the studies. Because they were not detectable by chest x-ray films, we did not include any tumors found solely by sputum cytology. For each identified case, we determined whether the patient was surgically explored and the tumor

RESULTS

The estimated survival distributions are plotted in Figures 1 to 3, and the five-year survivals are summarized in Table 3. First, for the stage I patients, we compared survival after surgery with survival of those who were not treated surgically in Sloan-Kettering, Hopkins and Mayo (Fig 1). We considered only lung cancer deaths including three postoperative deaths in Sloan-Kettering, two in Hopkins and two in Mayo as endpoints. Deaths from other causes were treated as withdrawals. The five-year

DISCUSSION

Patients in this study with lung cancer detected early who were untreated died of lung cancer; patients with lung cancer detected early who were treated by resection of their tumor had a high probability of survival. Survival from stage I lung cancer for surgically treated patients ranged from 63 to 76 percent at five years; for the cases not treated surgically the range was 0 to 19 percent, with only two survivors among the 45 cases not treated surgically at the three institutions.

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Supported in part by American Cancer Society grant RD306.

Manuscript received April 8; revision accepted July 10.

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Clinical InvestigationsThe Effect of Surgical Treatment on Survival from Early Lung Cancer: Implications for Screening

Section snippets

BACKGROUND AND METHODS

RESULTS

DISCUSSION

Chest

Chest

The National Cancer Institute Cooperative Early Lung Cancer Detection Program: results of the initial screen (prevalence): early lung cancer detection: introduction

Am Rev Respir Dis

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study

Am Rev Respir Dis

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study

Am Rev Respir Dis

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study

Am Rev Respir Dis

The natural history of lung cancer in a periodically screened population

Biometrics

Clinical Investigations
The Effect of Surgical Treatment on Survival from Early Lung Cancer: Implications for Screening