Chest
Original Research: Lung CancerCharacteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening
Section snippets
Materials and Methods
The NLST was a randomized screening trial comparing LDCT vs CXR (Fig 1A).4, 5 Subjects were enrolled from August 2002 through April 2004 and were randomly assigned to undergo three annual screenings with either LDCT scanning or CXR. Screening occurred from August 2002 through September 2007. Eligible participants were 55 to 74 years of age, had a history of cigarette smoking of at least 30 pack-years, and, if former smokers, had quit within the previous 15 years. Individuals who had previously
Results
There were 26,722 subjects randomized to the LDCT imaging arm, and the median follow-up was 6.5 years (Fig 1A). A total of 59% were men, and the median age at enrollment was 62 years. A total of 143 SCLC cases and 926 NSCLC cases were detected in the LDCT arm.
Table 1 presents LDCT arm SCLC cases according to stage and mode of detection. Of 143 SCLC cases, 49 (34.2%) were screen-detected, 15 (10.5%) were interval-detected, and 79 were nonscreened or postscreening (55.2%) cancers. Of 64 interval-
Discussion
Data from the NLST were analyzed to assess the characteristics and outcomes of SCLC with a focus on LDCT-detected cases. Novel observations from this analysis are as follows: (1) compared with NSCLC, a significantly higher proportion of SCLC cases were interval cancers, diagnosed within 1 year following a negative screening, and only one third of cases were screen detected; (2) as expected, the majority of SCLC cases were late-stage cancers but, surprisingly, the unfavorable stage distribution
Conclusions
Analysis of SCLC diagnosed during LDCT screening in the NLST shows that yearly LDCT screens detected a significant number of SCLC cases. Compared with NSCLC cases, a higher proportion of SCLC cases were interval detected than screen detected. However, no stage shift or survival benefit for screen-detected SCLC cases compared with interval- or postscreen-detected cases was observed. Even for screen-detected SCLC for which the lesion observed on the LDCT screen was small, the proportion of
Acknowledgments
Author contributions: A. T., E. S., and P. Pinsky conceived and designed the analysis, collected the data, performed the analysis and wrote the paper. P. Pattanayak collected the data, performed the analysis and contributed to manuscript writing. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Financial/nonfinancial disclosures: None declared.
Role of sponsors: The funding agencies had no role in the
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Dr Pattanayak is currently at Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.
FUNDING/SUPPORT: This work was supported in part by the Center for Cancer Research, National Cancer Institute at the National Institutes of Health [Grant ZIA BC 011793].