Patients with clinically diagnosed early-stage lung cancer were found to have improved cancer-specific survival, but not improved overall survival, suggesting overtreatment of benign disease, particularly smaller tumors, according to a study presented at the European Lung Cancer Conference (ELCC) 2016.1

Obtaining pathologic diagnosis for patients with early-stage lung cancer can often be difficult due to their medical comorbidities, tumor location, or patient preference. Therefore, researchers at Fox Chase Cancer Center in Philadelphia, PA, sought to investigate the trends in clinical diagnosis use and its effect on treatment outcomes in patients treated with radiation therapy.

For the study, researchers analyzed data from 7050 adult patients diagnosed with stage 1 lung cancer who underwent radiotherapy alone between 2004 and 2012 from the Surveillance, Epidemiology, and End Results (SEER) database. Of those, 90.8% were pathologically diagnosed and 9.2% were clinically diagnosed.

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Results showed that clinical diagnosis was associated with an improved cancer-specific survival (HR, 0.82; 95% CI, 0.71-0.96); however, it was not associated with an improved overall survival (HR, 1.01; 95% CI, 0.90-1.13).

“The main finding of our study is the improved cancer-specific survival in patients undergoing clinical versus pathologic diagnosis for stage 1 lung cancer without any difference in overall survival,” lead investigator Talha Shaikh, MD, a Radiation Oncology resident at Fox Chase Cancer Center said.

“We hypothesize that the disparity in cancer-specific survival between patients diagnosed clinically versus pathologically may be due to a greater number of patients in the clinical diagnosis arm having benign disease, which precludes them from developing a cancer-related death.”2

When researchers stratified patients by clinical T-stage, those with clinically diagnosed T1a disease had an improved cancer-specific survival (hazard ratio [HR], 0.75; 95% CI, 0.58-0.96; P = .022). There was also a trend towards improved cancer-specific survival in patients with clinical T1b tumors (HR, 0.74; 95% CI, 0.55-1.00; P = .052).

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The study further demonstrated that among patients clinically diagnosed, those with tumors between 0 cm and 1.9 cm had an improved cancer-specific survival (HR, 0.74; 95% CI, 0.58-0.99; P = .083).

“We advise taking a more prudent approach in patient selection to reduce overtreatment of potential benign disease, particularly in patients with smaller tumors,” Dr Shaikh said.


  1. Shaikh T, Churilla T, Murphy C, et al. Overtreatment of patients with clinically diagnosed early stage lung cancer. Oral presentation at: European Lung Cancer Conference 2016; April 13-16, 2016; Geneva, Switzerland.
  2. Patients with clinically diagnosed early-stage lung cancer potentially overtreated [news release]. Philadelphia, PA: Fox Chase Cancer Center; April 6, 2016. Accessed April 7, 2016.