Discussion
NSCLC, cancers, tumor, cancer, Lung cancer, lung cancer, tumors
CANCERS, LUNG, TUMOR, BREAST CANCER, CANCER, LUNG CANCER, LUNG CANCER, NSCLC, ONCOLOGY, TUMORS
We found that detection method has high independent prognostic value in NSCLC prognostic models beyond stage shift using data from the lung component of the PLCO screening trial. NSCLC patients with screen-detected tumors have better prognosis than those diagnosed by other detection methods. Results were robust to cohort selection and statistical modeling approach. This phenomenon has been noted before in breast cancer.This study’s findings do not imply benefit of CXR screening on NSCLC patients’ survival. Lung cancer mortality at 13 years post randomization was found to be similar between the Intervention and Control groupsOur study has several limitations. First, PLCO did not collect all variables used in the LCPI model. For example, the LCPI model used presence of actionable mutation and patient Eastern Cooperative Oncology Group (ECOG) status. Our conclusions about the independent prognostic value of detection method could be weakened or changed if variables such as presence of actionable mutations were included in CoxPH or RSF models.Second, since the biological mechanism behind why detection method is a significant prognostic variable is not completely evident, results may not generalize to other lung cancer cohorts in which different screening interventions are used. For example, the National Lung Screening Trial (NLST) studied the effect of low-dose CT screening on lung cancer mortalityIt is likely that in the future a larger share of cancers will be detected via screening either by regular image or blood exams. In the area of lung cancer, NLST showed that low-dose CT scans reduce lung cancer mortality by 20% among smokersOur findings imply that cancer detection method should be considered when constructing prognostic models. At present, detection method is not as widely collected as other variables used in prognostic models, such as age, sex, and tumor characteristics. Screening trials and cancer registries should collect cancer detection method, as it may be an important variable with prognostic value not captured by other measures.