Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Abstract

Objective: Routine surveillance imaging for patients with resected non-small cell lung cancer is standard for the detection of disease recurrence and new primary lung cancers. However, surveillance intensity varies widely in practice, and its impact on long-term outcomes is poorly understood. We hypothesized that surveillance intensity was not associated with 5-year overall survival in patients with resected stage I non-small cell lung cancer. Additionally, we examined patterns of recurrence and new primary lung cancer development. Methods: Cancer registrars at Commission on Cancer accredited institutions re-abstracted records to augment National Cancer Database patient data with information on comorbidities, imaging surveillance including intent and result of imaging, and recurrence (2007-2012). Pathologic stage I non-small cell lung cancer patients undergoing computed-tomography surveillance were placed into three imaging surveillance groups based on clinical practice guidelines: high intensity (3 month), moderate intensity (6 month), and low intensity (annual). Kaplan Meier analysis and Cox regression were used to compare overall survival among the three surveillance groups. Results: 2442 patients were identified, with 805 (33%), 1216 (50%), and 421 (17%) patients in the high, moderate, and low surveillance intensity groups, respectively. Five-year overall survival

Striking a balance: Surveillance of non–small cell lung cancer after resection

“…In terms of "how often to do it," we believe that the best evidence currently supports at least annual surveillance with no benefit to more than biannual surveillance during the first several years after surgery; beyond that time, annual LDCT seems adequate. 1,23 In conclusion, current guidelines for postresection surveillance tend to favor more aggressive CT-based imaging at 3-to 6-month intervals. Recent data suggest that this is likely too frequent with no impact on patient survival.…”

“…Similarly, more frequent surveillance was not associated with improved postrecurrence survival. A second and related study by Subramanian and colleagues 23 focused on a patient population with stage I lung cancer. A total of 2442 patients were followed for 5 years.…”

“…Strong recommendations beyond this are hard to make at this time, given a lack of prospectively collected data. 1,10,23 Appropriate long-term surveillance, especially beyond several years after surgery, is similarly challenging. Han and colleagues 24 found in a review of more than 20,000 lung cancer survivors who had survived beyond 5 years, the 10-year risk of a second primary lung cancer was 8.4%.…”

“…Most of the national databases that include surgically treated lung cancer patients do not routinely collect imaging studies that were performed during follow up. Indeed, the studies of McMurry and colleagues 1 and Subramanian and colleagues 23 are unique for examining tumor registry (not administrative) data in which supplementary longitudinal patient chart extraction was later performed. Such studies are obviously expensive with limited funding.…”

Rightsizing lung cancer surveillance

“…Both studies report high rates of early detection, high rates of treatment for recurrence or new primary lung cancer, and high 5-year survival rates for treated patients. 2,3 The study by Wang and colleagues 2 also provides a novel description of prevalent (ie, synchronous) lung cancers among survivors undergoing surveillance. 2 However, the investigation by Subramanian and colleagues 3 -using a unique data source consisting of tumor registry (not administrative) data supplemented by human chart abstraction-reveals no relationship between survival and the intensity of surveillance.…”