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Detection and treatment of lung adenocarcinoma at pre-/minimally invasive stage: is it lead-time bias?

  • Original Article – Cancer Research
  • Published:
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Abstract

Objectives

This study investigates whether lead-time bias contributes to the excellent survival of AIS and MIA.

Methods

We enrolled patients with resected adenocarcinoma from 2008 to 2012. Age, sex, smoke history, surgical approach, radiological features, invasive stage and postoperative follow-up data were documented. 1:1 PSM was performed to balance the influence of sex and smoking status on survival. After matching, the average age of the two groups was compared to calculate the lead time of diagnosis. The gain in life years for adenocarcinoma diagnosed at pre-/minimally invasive stage was estimated by subtracting the “lead time” and “median survival year of IAC” from “the life expectancy of AIS/MIA patients” referring to the Centre for Health and Information.

Results

There were 124 AIS/MIA patients and 1148 IAC patients. The frequency of female and never-smoking patients in AIS/MIA group was much higher than that in IAC group. PSM analysis identified 124 patient pairs. No cancer-related death and recurrence were observed among AIS/MIA patients 5 years after surgery. For IAC patients, the 5-year disease-specific survival rate was 73.5% and the median survival is 13.5 years. The average age of AIS/MIA group and IAC group are 53.6 years and 58.2 years, respectively. The lead time between diagnosis of AIS/MIA and IAC is 4.6 years. Referring to the Centre for Health and Information, the life expectancy of patients with AIS/MIA diagnosed at 53.6 years old is 28.9 years. With adjustment for the lead time, the gain in life years for adenocarcinoma diagnosed at pre-/minimally invasive stage is 10.8 years.

Conclusions

With adjustment for the lead time between diagnosis of AIS/MIA and IAC, resecting lung adenocarcinoma at pre-/minimally invasive stage can improve life expectancy. The excellent survival of AIS/MIA is not lead-time bias.

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Abbreviations

CT:

Computed tomography

AIS:

Adenocarcinoma in situ

MIA:

Minimally invasive adenocarcinoma

IAC:

Invasive adenocarcinoma

IASLC:

International Association for the Study of Lung Cancer

ATS:

American thoracic society

ERS:

European respiratory society

GGO:

Ground-glass opacity

PSM:

Propensity score matching

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Funding

This work was supported by the National Natural Science Foundation of China (81930073), Shanghai Municipal Science and Technology Major Project (Grant No. 2017SHZDZX01), Shanghai Shenkang Hospital Development Center City Hospital Emerging Cutting-edge Technology Joint Research Project (SHDC12017102) and Shanghai Municipal Health Commission Key Discipline Project (2017ZZ02025 and 2017ZZ01019).

Author information

Author notes

  1. Zelin Ma and Zezhou Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China

    Zelin Ma, Yang Zhang & Haiquan Chen

  2. Institution of Thoracic Oncology, Fudan University, Shanghai, 200032, China

    Zelin Ma, Zezhou Wang, Yuan Li, Yang Zhang & Haiquan Chen

  3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Zelin Ma, Zezhou Wang, Yuan Li, Yang Zhang & Haiquan Chen

  4. Department of Statistics, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

    Zezhou Wang

  5. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

    Yuan Li

Authors
  1. Zelin Ma
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  2. Zezhou Wang
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  3. Yuan Li
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  4. Yang Zhang
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Corresponding authors

Correspondence to Yang Zhang or Haiquan Chen.

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The authors declare no relevant conflicts of interest.

Ethical statement

The investigation was conducted based on the Declaration of Helsinki and approved by the Institutional Review Board of the Fudan University Shanghai Cancer Center (No. 090977-1). Each patient signed informed consent to allow biological samples to be pathologically examined.

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Ma, Z., Wang, Z., Li, Y. et al. Detection and treatment of lung adenocarcinoma at pre-/minimally invasive stage: is it lead-time bias?. J Cancer Res Clin Oncol 148, 2717–2722 (2022). https://doi.org/10.1007/s00432-022-04031-z

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