Background Diagnostic workup of small pulmonary nodules often requires follow-up CT scans to confirm nodule growth before invasive diagnostics or treatment. Purpose To confirm prior results from the International Early Lung Cancer Action Program (I-ELCAP) on quantifying decreases in lung cancer prognosis by using two large databases, the National Lung Screening Trial (NLST) and International Association for the Study of Lung Cancer (IASLC). Materials and Methods In this retrospective study, a model was developed to predict cure rates based on size of solid nodules using the NLST (August 2002 to summer 2007) and IASLC (January 2011 to December 2019) databases, focusing on stage I non-small cell lung cancer (NSCLC). Kaplan-Meier methods were used to calculate 10-year lung cancer-specific survival and 5-year overall survival rates for different tumor sizes. Tumor diameter increases after 90-, 180-, and 365-day delays were estimated using volume doubling times (VDTs) of 60, 120, and 240 days corresponding to fast, moderate, and slow tumor growth. Initial and delayed lung cancer cure rates were assessed across nine scenarios of time delays and tumor growth rates and compared with the previous results of the I-ELCAP database. Results Using regression models based on 166 NLST and 22 590 IASLC patients with NSCLC, 10-year lung cancer-specific survival and 5-year overall survival, respectively, for tumors 4.0-20.0 mm in diameter were estimated. For a 20.0-mm tumor with a 60-day VDT in the NLST database, the lung cancer-specific survival decreased from 83.4% to 76.5%, 66.8%, and 32.3% after 90, 180, and 365 days, respectively. The IASLC database showed similar decreases in 5-year overall survival, from 81.2% to 73.4%, 62.4%, and 23.3% after 90, 180, and 365 days, respectively. Comparison across NLST, IASLC, and I-ELCAP databases revealed minor variations in lung cancer cure rates between 79.9% and 83.4%, with reductions of 6.9%-8.3% after a 180-day delay with a 120-day VDT. Conclusion The NLST and IASLC databases confirmed prior estimates from the I-ELCAP database for the decrease in lung cancer prognosis due to diagnostic delays. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Park and Lee in this issue.

中文翻译：

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继发于诊断病情检查延迟对 I 期非小细胞肺癌预后的影响。


背景 小肺结节的诊断性检查通常需要后续 CT 扫描以确认结节生长，然后再进行侵入性诊断或治疗。目的 通过使用两个大型数据库，即国家肺癌筛查试验 （NLST） 和国际肺癌研究协会 （IASLC），确认国际早期肺癌行动计划 （I-ELCAP） 关于量化肺癌预后降低的先前结果。材料和方法 在这项回顾性研究中，使用 NLST（2002 年 8 月至 2007 年夏季）和 IASLC（2011 年 1 月至 2019 年 12 月）数据库开发了一个模型，根据实体结节的大小预测治愈率，重点关注 I 期非小细胞肺癌 （NSCLC）。采用 Kaplan-Meier 方法计算不同肿瘤大小的 10 年肺癌特异性生存率和 5 年总生存率。使用 60 、 120 和 240 天的体积倍增时间 （VDT） 估计延迟 90 、 180 和 365 天后肿瘤直径的增加，对应于快速、中度和缓慢的肿瘤生长。在时间延迟和肿瘤生长速率的 9 种情况下评估初始和延迟肺癌治愈率，并与 I-ELCAP 数据库的先前结果进行比较。结果 使用基于 166 例 NLST 和 22 590 例 IASLC 合并 NSCLC 患者的回归模型，分别估计直径为 4.0-20.0 mm 的肿瘤的 10 年肺癌特异性生存期和 5 年总生存期。对于 NLST 数据库中 VDT 为 60 天的 20.0 mm 肿瘤，90 、 180 和 365 天后肺癌特异性生存率分别从 83.4% 下降到 76.5% 、 66.8% 和 32.3%。IASLC 数据库显示 5 年总生存率也有类似的下降，在 90 天、 180 天和 365 天后分别从 81.2% 下降到 73.4%、62.4% 和 23.3%。 NLST 、 IASLC 和 I-ELCAP 数据库的比较显示，肺癌治愈率在 79.9% 和 83.4% 之间变化很小，在 120 天 VDT 延迟 180 天后降低 6.9%-8.3%。结论 NLST 和 IASLC 数据库证实了 I-ELCAP 数据库对诊断延迟导致肺癌预后降低的先前估计。© RSNA，2024 年本文提供补充材料。另见 Park 和 Lee 在本期的社论。