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. 2022 Oct;148(10):2717-2722.
doi: 10.1007/s00432-022-04031-z. Epub 2022 May 7.

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

Zelin Ma #  1   2   3 , Zezhou Wang #  2   3   4 , Yuan Li  2   3   5 , Yang Zhang  6   7   8 , Haiquan Chen  9   10   11
Affiliations

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

Zelin Ma et al. J Cancer Res Clin Oncol. 2022 Oct.

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.

Keywords: Adenocarcinoma in situ; Lead-time bias; Lung cancer screening; Minimally invasive adenocarcinoma.

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Conflict of interest statement

The authors declare no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the inclusion of patients and the estimation of survival statistics
Fig. 2
Fig. 2
The gain of life years for lung adenocarcinoma diagnosed at pre-/minimally invasive stage
Fig. 3
Fig. 3
Stable pure GGOs grow after a long-term follow-up
See this image and copyright information in PMC

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