Clinical lung cancer最新文献

{"title":"Refining Surveillance Guidelines after Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer","authors":"","doi":"10.1016/j.cllc.2024.06.008","DOIUrl":"10.1016/j.cllc.2024.06.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Stereotactic body radiation therapy (SBRT) is a treatment for patients with early-stage non-small cell lung cancer (ES-NSCLC). Surveillance guidelines vary after treatment. While patients are more likely to locally recur within 2 years of treatment, there remains a paucity of data on the benefit of frequent and long-term surveillance. We evaluated a cohort of NSCLC patients to evaluate surveillance patterns and outcomes.</p></div><div><h3>Materials and methods</h3><p><span>Patients with ES-NSCLC treated with SBRT were retrospectively evaluated. Imaging was reviewed after SBRT for evidence of recurrence or new malignancy. The median scan interval (MSI) was calculated as the median number of months between surveillance scans. The MSI between patients with or without new disease was compared by t-test. New </span>disease development and survival between patients with &lt;T2 or &gt;=T2 disease and with or without prior malignancy was compared using χ², Kaplan-Meier analysis, and Gray's test.</p></div><div><h3>Results</h3><p>A cohort of 168 patients with median follow up of 23.4 months met criteria for review with 50% developing new disease. MSI did not differ between patients with or without new disease. Patients with &gt;=cT2 tumors had worse overall survival and trended towards higher incidence of new disease. New disease continued to occur, even 5 years after treatment.</p></div><div><h3>Conclusion</h3><p>Increased scan frequency did not increase detection of new disease. Patients continued to fail 5 years after treatment. Larger tumors trended toward more frequent failures and those patients experienced worse OS. Surveillance guidelines should be optimized to prevent over surveillance after treatment and to continue long-term surveillance.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages e268-e276.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141566757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular Characteristics and Pretreatment Neutrophil-to-Lymphocyte Ratio as Predictors of Durable Clinical Benefit from Immune Checkpoint Inhibition in Non-Small Cell Lung Cancer","authors":"","doi":"10.1016/j.cllc.2024.06.006","DOIUrl":"10.1016/j.cllc.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><p><span>Prior research in non-small cell lung cancer (NSCLC) has shown that tumors with specific driver mutations may be less likely to respond to immune checkpoint inhibitors (ICI). In this analysis, we evaluated the characteristics of patients with durable clinical benefit (DCB) to ICI compared to those with no durable clinical benefit (NDB), with emphasis on the role of molecular alterations in </span><em>EGFR, ALK,</em> and <em>ROS1</em> and pretreatment neutrophil-to-lymphocyte ratio (NLR).</p></div><div><h3>Methods</h3><p>We retrospectively collected clinical characteristics and outcomes for patients who initiated ICI monotherapy for advanced NSCLC at Stanford University between April 2015 and May 2018. Patients were classified as having DCB if time on ICI therapy was greater than or equal to 180 days, or NDB if less than 180 days. Outcomes included best radiographic benefit while on ICI and survival from time of ICI initiation.</p></div><div><h3>Results</h3><p><span>Of 123 patients treated with ICI for NSCLC, 28 patients had DCB (23%), while 95 had NDB (77%). Median overall survival from initiation of ICI in the 33 patients with molecular alterations in </span><em>EGFR (n = 31), ALK</em>, or <em>ROS1</em> and NLR of 5.9 or higher was 2.0 months, compared to 8.1 months in patients with these genomic alterations and NLR less than 5.9. Median overall survival in patients without alterations in <em>EGFR, ALK,</em> or <em>ROS1</em> and NLR of 5.9 or higher was 4.3 months, compared to 12.1 months in patients with NLR less than 5.9 (<em>P</em> = .023).</p></div><div><h3>Conclusions</h3><p>Elevation in pretreatment NLR was associated with significantly lower overall median survival from initiation of ICI, particularly when in combination with NSCLC with alterations in <em>EGFR, ALK,</em> or <em>ROS1.</em> This finding could influence clinical practice as NLR is readily available through routine blood testing.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 550-559"},"PeriodicalIF":3.3,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141577393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gefitinib Resensitization After a TKI-Free Interval in Osimertinib Resistant Non–Small-Cell Lung Cancer: A Glimpse of Hope in Time of Crisis?","authors":"","doi":"10.1016/j.cllc.2024.06.003","DOIUrl":"10.1016/j.cllc.2024.06.003","url":null,"abstract":"<div><p></p><ul><li><span>•</span><span><p>After osimertinib<span> resistance some patients are still sensitive to EGFR blockage.</span></p></span></li><li><span>•</span><span><p>Gefitinib rechallenge seems effective after a TKI-free interval.</p></span></li><li><span>•</span><span><p><span>Liquid biopsy can track clonal evolution of </span><em>EGFR</em> mutated NSCLCs.</p></span></li><li><span>•</span><span><p>Detection of EGFR mutations on ctDNA can identify patients for this strategy.</p></span></li></ul></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages e262-e267"},"PeriodicalIF":3.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Emerging Role of Immune Checkpoint Blockade for the Treatment of Lung Cancer Brain Metastases","authors":"","doi":"10.1016/j.cllc.2024.06.004","DOIUrl":"10.1016/j.cllc.2024.06.004","url":null,"abstract":"<div><p><span>Lung cancer has the highest incidence of brain metastases (BM) among solid organ cancers. Traditionally </span>whole brain radiation therapy<span><span><span> has been utilized for non–small-cell lung cancer (NSCLC) BM treatment, although stereotactic radiosurgery<span> has emerged as the superior treatment modality for most patients. Highly penetrant central nervous system<span><span> (CNS) tyrosine kinase inhibitors have also shown significant CNS activity in patients harboring select oncogenic drivers. There is emerging evidence that patients without oncogene-driven tumors derive benefit from the use of </span>immune checkpoint inhibitors<span><span> (ICIs). The CNS activity of ICIs have not been well studied given exclusion of patients with active BM from landmark trials, due to concerns of inadequate CNS penetration and activity. However, studies have challenged the idea of an immune-privileged CNS, given the presence of functional lymphatic drainage within the CNS and destruction of the </span>blood brain barrier by BM. An emerging understanding of the interactions between tumor and CNS </span></span></span></span>immune cells<span><span> in the BM tumor microenvironment also support a role for </span>immunotherapy in BM treatment. In addition, posthoc analyses of major trials have shown improved intracranial response and survival benefit of regimens with ICIs over chemotherapy (CT) alone for patients with BM. Two prospective phase 2 trials evaluating </span></span>pembrolizumab<span><span> monotherapy and </span>atezolizumab plus CT in patients with untreated NSCLC BM also demonstrated significant intracranial responses. This review describes the interplay between CNS immune cells and tumor cells, discusses current evidence for ICI CNS activity from retrospective and prospective studies, and speculates on future directions of investigation.</span></span></p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 483-501"},"PeriodicalIF":3.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Design for a Phase II, Randomized, Multicenter Study of CtDNA-Guided Treatment With Furmonertinib Combined Therapy or Furmonertinib Alone for Untreated Advanced EGFR Mutant Non–small-cell Lung Cancer Patients: The FOCUS-C Study","authors":"","doi":"10.1016/j.cllc.2024.06.002","DOIUrl":"10.1016/j.cllc.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div><span>Third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have significant </span>antitumor activity<span> to advanced non–small-cell lung cancer (NSCLC) patients with classic EGFR<span> mutations. However, EGFR-TKI monotherapy shows poor efficacy in patients whose circulating tumor cell DNA (ctDNA) of EGFR mutations cannot be rapidly cleared.</span></span></div></div><div><h3>Materials and Methods</h3><div><span>As a third-generation TKI, furmonertinib has shown superior antitumor activity and minor toxicity. The FOCUS-C study is a prospective, multicenter, randomized controlled trial (NCT05334277) to explore the efficacy and safety of furmonertinib plus pemetrexed-platinum doublet chemotherapy with or without </span>bevacizumab<span><span> versus furmonertinib monotherapy in untreated advanced EGFR mutant NSCLC patients without EGFR clearance after the induction therapy of furmonertinib. Patients with EGFR clearance will still receive furmonertinib as Arm A. Patients without ctDNA clearance will be randomized in a 2:2:1 ratio as Arm B1 (furmonertinib), Arm B2 (furmonertinib combined with carboplatin<span> and pemetrexed for 4 cycles, and then furmonertinib and pemetrexed as maintenance therapy) and Arm B3 (Arm B2 regimen plus bevacizumab). The primary endpoint is progression-free survival (PFS) in Arm B2/B1. Secondary endpoints include PFS in Arm B3/B1, PFS in Arm A/B1, PFS in Arm B3/B2, objective response and disease control rate, </span></span>overall survival and safety in all Arms. Exploratory endpoints are focused on the efficacy based on plasma NGS at different timepoints.</span></div></div><div><h3>Conclusion</h3><div>This study will evaluate the efficacy and tolerability of furmonertinib plus carboplatin and pemetrexed with or without bevacizumab verses furmonertinib alone in untreated patients with advanced EGFR mutant NSCLC without EGFR clearance.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 7","pages":"Pages e357-e361.e17"},"PeriodicalIF":3.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery and Stereotactic Radiotherapy for Stage I Small-Cell Lung Carcinoma: A 25-Year Experience","authors":"","doi":"10.1016/j.cllc.2024.06.001","DOIUrl":"10.1016/j.cllc.2024.06.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Small-cell lung carcinoma (SCLC) is usually a wide-spread, highly-lethal malignancy but occasionally presents as localized, limited stage cancer amenable to local treatment. We reviewed our experience using surgery or stereotactic body radiotherapy (SBRT) to assess safety, survival rates and treatment toxicity in clinical stage I SCLC patients.</p></div><div><h3>Materials and Methods</h3><p>Electronic medical records of patients with clinical stage I lymph node-negative SCLC who underwent surgical resection or SBRT between 1996 and 2021 were retrospectively reviewed. A multivariable Cox Proportional Hazards model was constructed.</p></div><div><h3>Results</h3><p>Of 96 patients meeting inclusion criteria, 77 underwent resection and 19 underwent SBRT. Surgical patients were younger (mean 68.4 ± 9.2 years surgery versus 74.3 ± 6.6 years SBRT, <em>P</em> = .005) and had better pulmonary function (81.5 ± 19.6 FEV1% of predicted surgery versus 44.0 ± 20.9% SBRT, <em>P</em> &lt; .001). SBRT patients had significantly more comorbidities. For both cohorts, 59 tumors were pure SCLC and 37 were mixed SCLC/NSCLC histology. Median survivals were 21 months versus 31 months for SBRT and surgery patients respectively (<em>P</em> = .07). There were no treatment-related mortalities. Mean length of hospital stay for surgical patients was 5.4 ± 5.7 days. Survival was longer in lymph node-negative surgery patients (median 48 months node-negative versus 19 months node-positive, <em>P</em> = .04). For node-negative-surgery patients, the estimated 2- and 5-year survival rates are 60% and 48%.</p></div><div><h3>Conclusions</h3><p>Our single-institutional experience over 25 years demonstrates that local treatment with surgery or SBRT for clinical stage I SCLC is safe and effective, with survivals lower than similar stage non–small-cell carcinoma patients. However, our results compare favorably with prior small-cell surgical series and far better than reported results of chemoradiotherapy for similar stage patients, thereby validating current recommendations for employing surgery or SBRT for stage I SCLC.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 537-549.e2"},"PeriodicalIF":3.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424001104/pdfft?md5=2719331e3ee9daf272c5902b07058ecd&pid=1-s2.0-S1525730424001104-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' Preferences for Adjuvant Osimertinib in Non–Small-Cell Lung Cancer After Complete Surgical Resection: What Makes It Worth It to Patients?","authors":"","doi":"10.1016/j.cllc.2024.05.003","DOIUrl":"10.1016/j.cllc.2024.05.003","url":null,"abstract":"<div><h3>Background</h3><p><span>The ADAURA trial confirmed adjuvant Osimertinib's efficacy in EGFR-mutated Non–small-cell lung cancer (NSCLC), yet the limited mature </span>overall survival<span><span> (OS) data at approval poses a challenge. This study explores patient preferences in the </span>absence of complete OS information, hypothesizing that disease-free survival (DFS) benefit alone may influence adjuvant Osimertinib pursuit.</span></p></div><div><h3>Methods</h3><p>At Roswell Park Comprehensive Cancer Center (Jan-Dec 2021), patients assessed for adjuvant therapy received a survey probing OS and DFS preferences. Scenarios were (a) minimum OS justifying Osimertinib, (b) minimum DFS improvement justifying 3-years of adjuvant Osimertinib, (c) minimum 5-year DFS percent change, and (d) minimum OS justifying copay changes. Results were analyzed.</p></div><div><h3>Results</h3><p>Of 524 NSCLC patients, 51 participated. Scenario 1 saw 56% requiring a 12-month OS benefit for Osimertinib justification. In scenario 2, 72% deemed a 12-month DFS benefit sufficient. Scenario 3 revealed 31% opting out despite a 10% OS increase. Scenario 4 showed varied willingness to pay, with 33% unwilling to any shoulder copayment even with a 10-year OS benefit.</p></div><div><h3>Conclusion</h3><p>This study explores patient preferences without complete OS data, revealing diverse thresholds. Factors include employment, education, and willingness to pay. Findings underscore shared decision-making importance. Limitations include sample size, potential biases, and regional focus; larger cohorts are needed for validation.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 509-518"},"PeriodicalIF":3.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological Features and Survival Outcomes of Resected Lung Adenosquamous Carcinoma: Results From a Nationwide Japanese Registry Data","authors":"","doi":"10.1016/j.cllc.2024.05.010","DOIUrl":"10.1016/j.cllc.2024.05.010","url":null,"abstract":"<div><h3>Objectives</h3><p>The objective of this study was to clarify the clinicopathological features and prognostic factors of resected lung adenosquamous carcinoma (ASC) using a nationwide multi-institutional database.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed the records of 15,542 patients who underwent complete R0 resection for ASC (n = 326), adenocarcinoma (AC, n = 11,820), or squamous cell carcinoma (SC, n = 3396) from a Japanese lung cancer registry in 2010. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented.</p></div><div><h3>Results</h3><p>The ASC group showed worse recurrence-free and overall survival (RFS and OS) than both the AC and SC groups (5-year OS: 57.5% in ASC, 83.9% in AC [&lt; 0.001], and 62.3% in SC [<em>P</em> = .086]). In multivariate analyses, prognostic factors that affected OS for ASC included male, p-stage II-III, and postoperative complications within 30 days (grade ≥ 3 in the Clavien–Dindo classification). The sensitizing <em>EGFR</em> mutation was detected in 28 (21.5%) of 130 screened patients with ASC, but it did not affect either RFS, OS, or postrecurrence survival. Although more patients in the ASC group received adjuvant chemotherapy compared to the AC and SC groups, both multivariate and IPTW-adjusted analyses did not show positive impact of adjuvant chemotherapy on RFS and OS in ASC.</p></div><div><h3>Conclusions</h3><p>In this nationwide registry study, lung ASC was more aggressive than both AC and SC. No apparent survival impact of conventional adjuvant chemotherapy prompted us to investigate novel adjuvant strategies to optimize survival outcomes.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 519-528.e3"},"PeriodicalIF":3.3,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424001074/pdfft?md5=6c89cecd835bca966a9b78547b6e0efa&pid=1-s2.0-S1525730424001074-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tepotinib in a Patient With Advanced Non-Small Cell Lung Cancer Harboring MET Exon 14 Skipping Undergoing Concomitant Hemodialysis for Renal Failure: A Case Report","authors":"","doi":"10.1016/j.cllc.2024.05.008","DOIUrl":"10.1016/j.cllc.2024.05.008","url":null,"abstract":"<div><p></p><ul><li><span>•</span><span><p>Tepotinib, a potent, highly selective, once-daily, oral MET tyrosine kinase inhibitor, is approved in multiple countries for the treatment of advanced/metastatic <em>MET</em>ex14 skipping NSCLC and can be used in patients with mild-moderate renal impairment without dose adjustment. However, data in severe renal impairment are lacking.</p></span></li><li><span>•</span><span><p>We report the feasibility of using the standard dose of tepotinib (500 mg; 450 mg active moiety) in a patient with advanced <em>MET</em>ex14 skipping NSCLC with end-stage renal disease undergoing hemodialysis, who attained disease control, with only mild adverse events that did not necessitate dose adjustment.</p></span></li><li><span>•</span><span><p>Use of the standard dose was supported by tepotinib plasma concentration measurements, which fell within the expected range for a typical patient with NSCLC predicted using a population pharmacokinetic model and indicated no clinically relevant drug loss during dialysis.</p></span></li></ul></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 577-580"},"PeriodicalIF":3.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424001098/pdfft?md5=14101f14756f4deae6004a00cbe71a77&pid=1-s2.0-S1525730424001098-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routes to Diagnosis in Danish Lung Cancer Patients: Emergency Presentation, Age and Smoking History—A Population-Based Cohort Study","authors":"","doi":"10.1016/j.cllc.2024.05.009","DOIUrl":"10.1016/j.cllc.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><div>The fast-track cancer pathway aims to expedite diagnosis of lung cancer and treatment and is the preferred route to diagnosis. Diagnosis following an unplanned admission (unplanned route) has been associated with poor outcomes.</div></div><div><h3>Objective</h3><div>This study explores factors associated with lung cancer diagnosis following unplanned admissions, focusing on the elderly population.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using population-based data from Danish registries. Factors such as age, comorbidity, performance status, smoking history, socioeconomic parameters and treatment modality were analyzed in relation to route to diagnosis and prognosis.</div></div><div><h3>Results</h3><div>Among 17,835 patients, 16% were elderly (≥ 80 years). The unplanned route constituted 28% of diagnostic routes, with higher proportion among the elderly (33%). Poor performance status and advanced disease stage were associated with the unplanned route. Married patients were less likely to undergo an unplanned route to diagnosis. Smoking did not significantly influence diagnostic route. The adjusted odds ratio for curative treatment and dying 12 months after diagnosis, following unplanned route to diagnosis were 0.68 (95% CI, 0.61-0.76) and 1.48 (95% CI, 1.36-1.61), respectively.</div></div><div><h3>Conclusion</h3><div>Frailty (poor performance status and high burden of comorbidity) in addition to unfavorable socioeconomic factors, which all were more prevalent among elderly patients, were associated with undergoing an unplanned route to diagnosis. However, age itself was not. Diagnosis following unplanned admission correlated with reduced likelihood of curative treatment and poorer prognosis. Expanding screening initiatives to include frail elderly individuals living alone, along with alertness by primary care clinicians, is warranted to improve outcomes for these patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 7","pages":"Pages e348-e356"},"PeriodicalIF":3.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}