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J Thorac Cardiovasc Surg 2003;125:108-114
© 2003 The American Association for Thoracic Surgery
General Thoracic Surgery (GTS) |
From the Oregon Health Sciences University Department of Surgery, Portland, Ore,a Division of Cardiothoracic Surgery, Department of Surgery, San Francisco Veterans Affairs Medical Center, and University of California, San Francisco,b and the Division of Biostatistics, University of California, San Francisco Cancer Center, San Francisco, Calif.c
Supported in part by a Department of Veterans' Affairs Advanced Research Career Development Award. Current affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.
Received for publication June 28, 2001. Revisions requested Aug 31, 2001; revisions received Sept 10, 2002. Accepted for publication Sept 13, 2002. Address for reprints: Mark I. Block, MD, Division of Cardiothoracic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, 409 CSB, Charleston, SC 29425 (E-mail: blockm{at}musc.edu).
Objective: Screening for lung cancer will discover many nodules of indeterminate pathology. Observation has the theoretic risk of permitting dissemination of a localized cancer and worsening prognosis, whereas immediate evaluation of benign conditions generates morbidity and cost. This study was conducted to assess the effect of delay in surgical intervention on survival for patients with early stage non-small cell lung cancer.
Methods: Records for patients with resected pathologic stage I and II non-small cell lung cancer (1989-1999) were abstracted for patient age, race, sex, medical history, date of presentation, date and type of surgical treatment, pathologic stage, and date of death or last follow-up. Kaplan-Meier survival analysis was performed to test for the effect of delay (time from presentation to surgical intervention) on survival.
Results: Eighty-four patients were identified. Median age was 66 years, median preoperative interval was 82 days (range, 1-641 days), and median follow-up was 3.3 years (range, 5 days-11.9 years). Median survival was 3.7 years. Overall 5-year survival was 40%; disease-specific 5-year survival was 63%. Log-rank analysis of the effect of delay on overall survival generated a P value of .54, with an estimated hazard ratio for a 90-day delay of 1.06 (95% confidence interval, 0.87-1.30).
Conclusions: For this population, we were unable to detect a significant effect of delay on prognosis. Although these results suggest that the risk of judicious observation of indeterminate pulmonary nodules might be low, the 95% confidence interval is broad. Larger sample sizes are needed to reach definitive conclusions.
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