Computed tomographic screening for lung cancer: the relationship of disease stage to tumor size.
BACKGROUND
The relationship of lung cancer stage to tumor diameter has been identified as a prognostic indicator. We report on the stage-size relationship of these asymptomatic, latent lung cancer cases diagnosed by computed tomographic screening.


METHODS
Baseline and repeat screening of 28 689 people following the International Early Lung Cancer Action Program regimen of screening has resulted in 464 diagnoses of lung cancer. Each case was characterized according to tumor diameter, consistency (solid, part solid, or nonsolid), and the presence or absence of identifiable metastases (N0 M0) at the time of diagnosis, regardless of whether it was delayed.


RESULTS
For the 436 non-small cell carcinomas, the percentages of cases with no metastases (N0 M0) were 91%, 83%, 68%, and 55% for the categories 15 mm or less, 16 to 25 mm, 26 to 35 mm, and 36 mm or greater, respectively. The gradients in the successive percentages of N0 M0 cases were significantly different (P = .02, 1-sided), except between the last 2 categories, and held for solid nodules, were suggestive for part-solid ones, but were not suggestive for nonsolid ones. For the 28 small cell carcinomas, the percentages of N0 M0 cases were 67% and 23% (P = .01, 1-sided), respectively, for those 25 mm or less compared with those greater than 25 mm.


CONCLUSIONS
Lymph node status has a strong relationship to tumor diameter for non-small cell and small cell cancers. The percentages of N0 M0 cases in screen-diagnosed lung cancers are much higher than previously reported in the Surveillance, Epidemiology, and End Results registry. These results provide direct evidence of a stage-size relationship in a screened population.
Henschke
Claudia I
CI
Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10021, USA. chensch@med.cornell.edu
Yankelevitz
David F
DF
Miettinen
Olli S
OS
D000230:Adenocarcinoma / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D014057:Tomography, X-Ray Computed