密西西比三角洲队列中通过筛查和偶然肺结节计划确诊的肺癌切除结果。

IF 3 Q2 ONCOLOGY

JTO Clinical and Research Reports Pub Date : 2024-08-01 DOI:10.1016/j.jtocrr.2024.100684

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Survival was analyzed using Kaplan-Meier plots, log-rank tests, and Cox regression, comparing aggregate and stage-stratified survival across cohorts with Tukey’s method for multiple testing.</p></div><div><h3>Results</h3><p>Of 1588 patients, 111 patients (7%), 357 patients (22.5%), and 1120 patients (70.5%) were diagnosed through screening, pulmonary nodule, and non–program-based pathways; 0% versus 9% versus 6% were older than 80 years (<em>p</em> = 0.0048); 17%, 23%, and 24% had a Charlson Comorbidity score greater than or equal to 2 (<em>p</em> = 0.0143); 7%, 6%, and 9% had lepidic adenocarcinoma; 26%, 31%, and 34% had poorly or undifferentiated tumors (<em>p</em> = 0.1544); and 93%, 87%, and 77% had clinical stage I (<em>p</em> < 0.0001).</p><p>Aggregate 5-year survival was 87%, 72%, and 65% (<em>p</em> = 0.0009), including 95%, 74%, and 74% for pathologic stage I. Adjusted pairwise comparisons showed similar survival in screening and nodule program cohorts (<em>p</em> = 0.9905). 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引用次数: 0

摘要

方法我们假设分期生存率的差异表明生物学侵袭性的差异以及可能存在的时间长度和过度诊断偏倚，因此我们评估了一组进行了根治性切除术的患者，并按诊断途径进行了分类：筛查、偶然肺结节计划和非计划。我们使用卡普兰-梅耶图、对数秩检验和 Cox 回归分析了生存率，并使用 Tukey's 方法进行多重检验，比较了不同队列的总生存率和分期生存率。0048）；17%、23%和24%的患者Charlson合并症评分大于或等于2（P = 0.0143）；7%、6%和9%的患者为鳞状腺癌；26%、31%和34%的患者为低分化或未分化肿瘤（P = 0.1544）；93%、87%和77%的患者为临床I期（P < 0.0001）。5年总生存率分别为87%、72%和65%（p = 0.0009），其中病理分期I的生存率分别为95%、74%和74%。调整后的配对比较显示，筛查和结节计划队列的生存率相似（p = 0.9905）。然而，筛查队列和非计划队列之间（p = 0.0007，调整后危险比为 0.33 [95% 置信区间：0.18-0.6]）以及结节队列和非计划队列之间（调整后危险比为 0.77 [95% 置信区间：0.61-0.99]）存在显著差异。I 期比较得出的 p = 0.2256、0.1131 和 0.911。结论在通过筛查或偶然肺结节项目确诊的 NSCLC 患者中，时长偏差和过度诊断偏差均不明显。

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Outcomes of Resected Lung Cancer Diagnosed Through Screening and Incidental Pulmonary Nodule Programs in a Mississippi Delta Cohort

Introduction

Early lung cancer detection programs improve surgical resection rates and survival but may skew toward more indolent cancers.

Methods

Hypothesizing that differences in stage-stratified survival indicate differences in biological aggressiveness and possible length-time and overdiagnosis bias, we assessed a cohort who had curative-intent resection, categorized by diagnostic pathways: screening, incidental pulmonary nodule program, and non–program based. Survival was analyzed using Kaplan-Meier plots, log-rank tests, and Cox regression, comparing aggregate and stage-stratified survival across cohorts with Tukey’s method for multiple testing.

Results

Of 1588 patients, 111 patients (7%), 357 patients (22.5%), and 1120 patients (70.5%) were diagnosed through screening, pulmonary nodule, and non–program-based pathways; 0% versus 9% versus 6% were older than 80 years (p = 0.0048); 17%, 23%, and 24% had a Charlson Comorbidity score greater than or equal to 2 (p = 0.0143); 7%, 6%, and 9% had lepidic adenocarcinoma; 26%, 31%, and 34% had poorly or undifferentiated tumors (p = 0.1544); and 93%, 87%, and 77% had clinical stage I (p < 0.0001).

Aggregate 5-year survival was 87%, 72%, and 65% (p = 0.0009), including 95%, 74%, and 74% for pathologic stage I. Adjusted pairwise comparisons showed similar survival in screening and nodule program cohorts (p = 0.9905). Nevertheless, differences were significant between screening and non–program-based cohorts (p = 0.0007, adjusted hazard ratio 0.33 [95% confidence interval: 0.18–0.6]) and between nodule and nonprogram cohorts (adjusted hazard ratio 0.77 [95% confidence interval: 0.61–0.99]). Stage I comparisons yielded p = 0.2256, 0.1131, and 0.911. In respective pathways, 0%, 2%, and 2% of patients with stage I disease who were older than 80 years had a Charlson score greater than or equal to 2 (p = 0.3849).