title: Small-cell carcinoma of the lung detected by CT screening: stage distribution and curability.
abstract: BACKGROUND
  Prognosis is incompletely known for small-cell lung carcinoma (SCLC) detected by CT screening of at-risk subjects.
  
  
  METHODS
  A multinational study of baseline and annual repeat CT screening for lung cancer of 48,037 at-risk subjects yielded 48 persons (median age 68 years) with SCLC. Stage (tumor, node, metastasis system) distribution and death rates were compared with those of 7960 usual-care SCLC subjects (chi-square or Fisher exact testing, as appropriate), as reported by the International Association for the Study of Lung Cancer. Cure was estimated by Kaplan-Meier analysis.
  
  
  RESULTS
  Forty-four (92%) of the patients were asymptomatic at screening CT detection of their SCLC; four (8%) presented with cancer-related symptoms before the next scheduled repeat screening. SCLC was diagnosed in clinical stages IA and IV in 16 (33%) and 7 (15%), respectively, of 48 patients, compared to 211 (3%) and 4530 (57%), respectively, of the 7960 patients in the usual-care study (P<0.0001). Tumor diameter was ≤3.0 cm for each of the 16 subjects in clinical stage I. The percentage of clinical stage I SCLC-related deaths within 5 years was lower in the screening study than in the usual-care study (44% vs. 71%, P=0.03), as was also the percentage of advanced stage (IIIB plus IV) SCLC-related deaths (62% vs. 94%, P<0.0001).
  
  
  CONCLUSIONS
  Compared to usual-care detection of SCLC, CT screening identified a shift toward early stage and away from late stage disease, and was associated with a decrease in deaths from the disease.
authors.affiliation: Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: John H M
authors.initials: JH
authors.lastname: Austin
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.forename: Belinda M
authors.initials: BM
authors.lastname: D'Souza
authors.forename: David F
authors.initials: DF
authors.lastname: Yankelevitz
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D014057:Tomography, X-Ray Computed