97O - Overtreatment of patients with clinically diagnosed early stage lung cancer

Date 14 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Multidisciplinary management of thoracic malignancies
Topics Non-Small Cell Lung Cancer
Surgical Oncology
Radiation Oncology
Presenter Talha Shaikh
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors T. Shaikh1, T. Churilla2, C. Murphy2, N.G. Zaorsky2, A. Haber2, M. Hallman2, J.E. Meyer2
  • 1Radiation Oncology, Fox Chase Cancer Center, 19111 - Philadelphia/US
  • 2Radiation Oncology, Fox Chase Cancer Center, Philadelphia/US



Obtaining pathologic diagnosis for patients with early stage lung cancer is often difficult due to medical comorbidities, tumor location, or patient preference. The purpose of this study was to assess the trends in clinical diagnosis use and its impact on treatment outcomes in patients receiving radiotherapy for early stage lung cancer.


The Surveillance, Epidemiology, and End Results registry was queried from 2004 to 2012 for patients >18 years old diagnosed with Stage I (clinical T1a-T2a) lung cancer who underwent radiation therapy alone. Trends in diagnostic confirmation patterns for Stage I lung cancer patients were characterized. Cox proportional hazards model was used to assess overall survival (OS), competing risk regression analysis was used to assess cancer specific survival (CSS).


A total of 7050 patients were included in the analysis; of these, 6399 (90.8%) were pathologically diagnosed and 651 (9.2%) were clinical diagnosed. There was no significant change in the utilization of clinical versus pathologic diagnosis during the study time period (p = 0.172). On multivariable analysis, clinical diagnosis was associated with an improved CSS (HR 0.82 95% CI 0.71–0.96) but was not associated with an improved OS (HR 1.01 95% CI 0.90–1.13). When stratifying by clinical T-stage, clinically diagnosed T1a patients had an improved CSS (HR 0.75 95% CI 0.58–0.96 p = 0.022). There was a trend towards improved CSS in patients with clinical T1b tumors (HR 0.74 95% CI 0.55–1.00 p = 0.052). When examining outcomes by interval quartile size, patients with tumors between 0–1.9 cm had an improved CSS (HR 0.74 95% CI 0.58–0.99 p = 0.040) in the clinical diagnosis group. There was a trend towards an improved CSS in patients with 2.0–2.7 cm tumors (HR 0.78 95% CI 0.58–1.03 p = 0.083). There was a stepwise increase in the hazard ratio for CSS according to T-stage and tumor size when comparing clinically diagnosed versus pathologically diagnosed tumors.


The improved CSS in clinically diagnosed patients suggests treatment of benign disease particularly in smaller tumors. Prudent patient selection is needed to reduce the potential for overtreatment.

Clinical trial identification

Legal entity responsible for the study

Department of Radiation Oncology, Fox Chase Cancer Center


Department of Radiation Oncology, Fox Chase Cancer Center


All authors have declared no conflicts of interest.