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Unexpected Observations on Tumor Size and Survival in Stage IA Non-small Cell Lung Cancer

William C. Black, MD
Author and Funding Information

Affiliations: Dartmouth Medical School, Lebanon, NH
 ,  Dr. Black is from the Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, and the Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH.

Correspondence to: William C. Black, MD, Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756; e-mail: William.Black@Hitchcock.org



Chest. 2000;117(6):1532-1534. doi:10.1378/chest.117.6.1532
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Although screening for lung cancer with chest radiography has never been shown to be effective, there is growing enthusiasm for screening with low-dose helical CT, which is a much more sensitive technique. In a recently published study,1 chest radiography detected only 4 of 23 stage I lung cancers detected by helical CT, 15 of which were ≤ 1.0 cm in diameter. Underlying the enthusiasm for screening with CT is the premise that earlier detection will increase the curability of this disease. In this issue of CHEST (see page 1568), however, this basic premise is challenged by a report on the survival of 510 consecutive patients with stage IA non-small cell lung cancer. Using a Cox proportional hazards model, Patz et al found no statistically significant relationship between tumor size and survival. Given that stage is the single strongest predictor of survival for lung cancer overall, these findings are surprising and beg the following questions. Why did the authors not find an inverse relationship between tumor size and survival, and how does this relate to the issue of screening with helical CT?

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