Comparing U.S. Preventive Services Task Force 2013 versus 2021 lung cancer screening eligibility.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 13-13
Author(s):  
Matthew Smeltzer ◽  
Wei Liao ◽  
Meghan Brooke Taylor ◽  
Carrie Fehnel ◽  
Nicholas Faris ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Task Force ◽  
Clinical Stage ◽  
Lung Nodule ◽  
Preventive Services ◽  
Small Cell ◽  
Term Survival ◽  
Screening Criteria ◽  
Community Healthcare ◽  
The Impact

13 Background: Early detection of lung cancer provides the best opportunity for long-term survival. In 2021 US Preventive Services Task Force (USPSTF) expanded the 2013 risk-based Low-dose CT (LDCT) screening criteria, in part to reduce unintended race and gender disparities in lung cancer detection. We evaluated the impact of the updated USPSTF criteria in a cohort of patients from an incidental lung nodule program (ILNP). Methods: We implemented an ILNP in a community healthcare system in the mid-south US. Patients with lung lesions on routinely-performed radiologic studies were triaged using evidence-based guidelines. We prospectively tracked patient demographics, clinical characteristics, procedures, complications, and health outcomes. We classified all patients in the ILNP cohort based on USPSTF 2013 and 2021 screening criteria. Statistical analysis used the chi-square test. Results: The ILNP cohort included 14,642 patients from 2015-2021. This cohort was 56% female, 65% White, 29% Black, with a median age of 64 years. Overall 1,581 (10.8%) met 2013 and 2,051 (14.0%) met 2021 USPSTF criteria. 1.9% of subjects eligible by 2013 criteria were diagnosed with lung cancer compared to 2.2% by 2021 criteria. 470 additional patients met screening criteria when we expanded from USPSTF 2013 to 2021. As expected, these patients were younger and less likely to have Medicare insurance. These additional eligible patients were significantly more likely to be female (58% v 49%, p = 0.0011) or Black (28% vs. 18%, p < 0.0001) compared to those eligible by 2013 criteria. 44 of the 470 (9%) were diagnosed with cancer: 36% adenocarcinoma, 18% squamous, and 11% small cell, 11% non-lung primary, 9% non-small cell lung cancer NOS, and 15% other or unknown histology. The median tumor size was 3 cm with an interquartile range from 1.7 to 4.2 cm. The clinical stage distribution was 34% I, 4.5% II, 15.9% III, and 31.8% IV. Conclusions: In this selective community-based cohort, USPSTF 2021 criteria identified a higher percentage of subjects with lung cancer and were more inclusive of women and minorities compared to USPSTF 2013 criteria.

Lobe-specific lymph node dissection in stage IA non-small-cell lung cancer: a retrospective cohort study

2020 ◽  
Author(s):  
Tariq Ziad Abughararah ◽  
Yong Ho Jeong ◽  
Fahd Alabbood ◽  
Yooyoung Chong ◽  
Jae Kwang Yun ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Clinical Stage ◽  
Lower Lobe ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Ia ◽  
The Impact

Abstract OBJECTIVES To investigate lymph node (LN) metastasis according to tumour location and assess the impact of lobe-specific LN dissection on survival in stage IA non-small-cell lung cancer (NSCLC). METHODS We retrospectively analysed the data of patients with clinical stage IA NSCLC treated with lobectomy and systematic LN dissection at Asan Medical Center (Seoul, Korea) between June 2005 and April 2017. Patients who received neoadjuvant therapy had multiple primary tumours or missed the follow-up during the first postoperative year were excluded. The patients were divided into five groups according to involved lung lobes: right upper lobe (RUL), right middle lobe (RML), right lower lobe (RLL), left upper lobe (LUL) and left lower lobe (LLL), which were further divided into subgroups according to LN station metastasis. Overall survival (OS) and the incidence of metastasis were calculated for each subgroup. Efficacy indices (EIs) were calculated to determine the correlation between each lung lobe and LN station, and the impact of the dissection of these stations on survival. RESULTS A total of 1202 patients were analysed. The 5-year OS in the RUL, RML, RLL, LUL and LLL groups was 74%, 88%, 78%, 80% and 75%, respectively. The incidence of single LN station metastasis was 11%, 10%, 10%, 16% and 14%, respectively. The lobe-specific LNs for RUL, RML, RLL, LUL and LLL were stations 2/3/4, 4/7, 2/4/7, 4/5/6 and 6/7/9, respectively. Moreover, the LN stations with high EIs for RUL, RML, RLL, LUL and LLL were 4, 7, 7, 5 and 7, respectively. In the RUL group, the incidence of metastasis to stations 2, 3 and 4 was 2.3%, 0.5% and 7.6%, and the EI was 0.8, 0.3 and 4.3, respectively. In RML, the incidence of metastasis to stations 4 and 7 was 4% and 6%, and the EI was 1.3 and 2.4, respectively. In RLL, the incidence of metastasis to stations 2, 4 and 7 was 4.4%, 5.6% and 8.3%, and the EI was 1.3, 1.4 and 3.3, respectively. In LUL, the incidence of metastasis to stations 4, 5 and 6 was 1.4%, 11.8% and 2.5%, and the EI was 0.4, 7.1 and 0.5, respectively. In LLL, the incidence of metastasis to stations 6, 7 and 9 was 1.1%, 5.7% and 1.7%, and the EI was 0.6, 2.3 and 0.5, respectively. Furthermore, the OS of patients with lobe-specific LN metastasis was statistically significantly different from that of the non-lobe-specific LN metastasis group with P-values of &lt;0.001 for RUL, 0.002 for RML, 0.002 for RLL, 0.001 for LUL and 0.003 for LLL. CONCLUSIONS Our findings support the use of lobe-specific LN dissection in stage IA NSCLC. When LN stations with high EI were negative, LN metastasis in other stations was unlikely. The incidence of LN metastasis beyond lobe-specific LN stations was ∼1% in all subgroups. Dissection of non-lobe-specific LNs may not improve the OS; however, prospective randomized controlled trials are needed to modify the standard approach.

scholarly journals Impact of the Extent of Lymph Node Dissection on Precise Staging and Survival in Clinical I–II Pure-Solid Lung Cancer Undergoing Lobectomy

2021 ◽  
Vol 19 (4) ◽  
pp. 393-402
Author(s):  
Donglai Chen ◽  
Yiming Mao ◽  
Junmiao Wen ◽  
Jian Shu ◽  
Fei Ye ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Stage ◽  
Structural Break ◽  
Optimal Number ◽  
Lower Probability ◽  
Stage Migration ◽  
Term Survival ◽  
Accurate Staging ◽  
Nodal Upstaging ◽  
The Impact

Background: This study sought to determine the optimal number of examined lymph nodes (ELNs) and examined node stations (ENSs) in patients with radiologically pure-solid non–small cell lung cancer (NSCLC) who underwent lobectomy and ipsilateral lymphadenectomy by investigating the impact of ELNs and ENSs on accurate staging and long-term survival. Materials and Methods: Data from 6 institutions in China on resected clinical stage I–II (cI–II) NSCLCs presenting as pure-solid tumors were analyzed for the impact of ELNs and ENSs on nodal upstaging, stage migration, recurrence-free survival (RFS), and overall survival (OS). Correlations between different endpoints and ELNs or ENSs were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. Results: Both ELNs and ENSs were identified as independent prognostic factors for OS (ENS hazard ratio [HR], 0.690; 95% CI, 0.597–0.797; P<.001; ELN HR, 0.950; 95% CI, 0.917–0.983; P=.004) and RFS (ENS HR, 0.859; 95% CI, 0.793–0.931; P<.001; ELN HR, 0.960; 95% CI, 0.942–0.962; P<.001), which were also associated with postoperative nodal upstaging (ENS odds ratio [OR], 1.057; 95% CI, 1.002–1.187; P=.004; ELN OR, 1.186; 95% CI, 1.148–1.226; P<.001). A greater number of ELNs and ENSs correlated with a higher accuracy of nodal staging and a lower probability of stage migration. Cut-point analysis revealed an optimal cutoff of 18 LNs and 6 node stations for stage cI–II pure-solid NSCLCs, which were validated in our multi-institutional cohort. Conclusions: Extensive examination of LNs and node stations seemed crucial to predicting accurate staging and survival outcomes. A threshold of 18 LNs and 6 node stations might be considered for evaluating the quality of LN examination in patients with stage cI–II radiologically pure-solid NSCLCs.

Long-term survival comparison of stereotactic radiotherapy versus surgery for elderly patients with clinical stage T1-T2 non-small cell lung cancer.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 8511-8511 ◽  
Author(s):  
Feng-Ming Spring Kong ◽  
Chunyu He ◽  
Yong Zang ◽  
Sandra K. Althouse ◽  
Lautenschlaeger Tim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Stereotactic Radiotherapy ◽  
Clinical Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Term Survival ◽  
Stage T1

scholarly journals The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer

Lung Cancer ◽  
2015 ◽  
Vol 90 (3) ◽  
pp. 554-560 ◽  
Author(s):  
Brian C. Gulack ◽  
Chi-Fu Jeffrey Yang ◽  
Paul J. Speicher ◽  
James M. Meza ◽  
Lin Gu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Tumor Size ◽  
Clinical Stage ◽  
Small Cell ◽  
Stage I ◽  
Small Cell Lung ◽  
The Impact
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