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David S. Ettinger, MD, FACP, FCCP

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Potential Correlation Between Stage Shift and Survival Among Patients With NSCLC

By: Vanessa A. Carter, BS
Posted: Wednesday, January 19, 2022

Emanuela Taioli, MD, PhD, of the Icahn School of Medicine at Mount Sinai, New York, and colleagues evaluated the correlation between stage shift and survival among patients with non–small cell lung cancer (NSCLC). Publishing their findings in JAMA Network Open, these investigators reported a potential association between decreased mortality and a diagnostic shift from later to earlier stage, suggesting that treatment studies must account for stage shift when investigating survival outcomes.

“This is the first time a large population-based study has demonstrated decreased lung cancer mortality with early detection—finding cancer in earlier stages—when tumors are smaller and more curable,” stated the study’s initial author Raja Flores, MD, also of the Icahn School of Medicine, in a Mount Sinai Press release. “This study emphasizes the impact of screening followed by surgical intervention to save lives in people at high risk for lung cancer.”

This retrospective study collected data from the Surveillance, Epidemiology, and End Results (SEER) registries from 312,382 patients with NSCLC from 2006 to 2016. The year of death was used to evaluate incidence-based mortality, and shifts in clinical stage, histology, and diagnostic characteristics were examined.

The median patient age was 68, and 52.2% of individuals had adenocarcinoma histology. Within 5 years of diagnosis, incidence-based mortality decreased from 2006 to 2016. A significant association was also found between the year of diagnosis and clinical stage, with an increase of stage I or II diagnosis from 26.5% to 31.2%, and stage III or IV diagnosis decreasing from 70.8% to 66.1%. The year of diagnosis also appeared to correlate with tumor histology (P < .001).

The investigators reported a significant increase in adenocarcinomas from 2006 (42.9%) to 2016 (59.0%). Patients with stage I or II NSCLC had significantly better survival compared with those who had stage III or IV or missing stage status (P < .001). The median survival for patients with stage I or II disease was 57 months, and for those with stage III or IV disease, it was 7 months.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.


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