Clinical characteristics and survival of patients with surgically resected, incidentally detected lung cancer.
BACKGROUND
There is little information on the clinical characteristics and outcomes of patients with surgically resected, incidentally detected lung cancers. Our hypothesis was that among patients with surgically resected non-small cell lung cancer (NSCLC), incidentally detected cancers were common, were less likely to require pneumonectomy, and were associated with better stage-adjusted survival.


METHODS
Two hundred seventy-four patients with NSCLC who underwent surgical resection between 1999 and 2004 were studied. The clinical characteristics of patients with incidentally detected and symptomatic NSCLC were compared. A proportional hazards model was used to compare the stage-adjusted mortality rate of patients with incidentally detected and symptomatic NSCLC.


RESULTS
One hundred patients (36%) had incidentally detected NSCLC. Patients with incidentally detected NSCLC had smaller and earlier-stage cancers, were less likely to undergo pneumonectomy (3% versus 13%, p = 0.005), and were more likely to have bronchioloalveolar carcinoma (15% versus 5%, p = 0.003). Patients with incidentally detected cancers had a stage-adjusted hazards ratio (HR) of mortality of 0.9 compared with symptomatic patients (0.6-1.4, p = 0.64). Patients with cancers detected incidentally on computed tomography (CT) had a stage-adjusted HR of 0.5 (0.2-1.5, p = 0.15).


CONCLUSIONS
Early-stage NSCLC is commonly detected incidentally. Patients with incidentally detected lung cancers are more likely to have bronchioloalveolar carcinoma histology, less likely to undergo pneumonectomy, and overall have similar stage-adjusted survival compared with symptomatic patients. Patients with cancers detected incidentally by CT scan may have better stage-adjusted survival, but our study was not sufficiently powered to detect this effect.
Raz
Dan J
DJ
Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, CA 94131, USA. Dan.raz@ucsf.edu
Glidden
David V
DV
Odisho
Anobel Y
AY
Jablons
David M
DM
D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis