Abstract 4449: Initial medical attention on patients with stage I or II non-small cell lung cancer
Authors: Chen Xing , Gorlov Ivan P. , Ying Jun , Merriman Kelly W. , Kimmel Marek , Lu Charles , Reyes-Gibby Cielito C. , Gorlova Olga Y. 
Published: August 2012

Abstract
Background Unlike advanced LC where detection is thought to be always triggered by symptoms, detection of early stage NSCLC patients is commonly believed to be incidental. This is because symptoms at an earlier stage of LC are considered rare and not related to tumor and are largely ignored.Understanding the reasons that caused initial detection of these patients is important for early diagnosis. However, these reasons are not well studied. Methods We retrospectively reviewed medical records of patients diagnosed with stage I or II NSCLC between 2000 and 2009 at UT MD Anderson Cancer Center. Suggestive LC-symptoms or other reasons that caused detection were extracted from patients’ medical records. We applied univariate and multivariate analysis to evaluate the association of suggestive LC-symptoms with tumor size and patient survival. Results Of the 1396 early stage LC patients, 733 (52.5%) presented with suggestive LC-symptoms as chief complaint. 347 (24.9%) and 287 (20.6%) were diagnosed because of regular check-ups and evaluations for other diseases, respectively. In particular, for the stage IA patients, 43.1% went to doctors because of suggestive LC-symptoms. The most common complaints were cough (with or without blood), dyspnea (shortness of breath), pain (scapula and chest). No difference in the proportion of suggestive LC-symptom-caused detection was observed by sex and ethnicity. Younger patients (age ≤ 68, median) were diagnosed because of symptoms more often than did older patients (age &gt; 68, P &lt; .001). Recent quitters and current smokers presented more symptom-caused detection than never and former smokers (P = .006). Squamous cell carcinoma caused more symptoms than adenocarcinoma (P &lt;.001). The proportion of suggestive LC-symptom-caused detection had a linear relationship with the tumor size (correlation 0.96; with p &lt; .0001). After age, gender, race, smoking status, therapy, and stage adjustment, the symptom-caused detection showed no significant difference in overall and LC-specific survival (power &gt; 0.85) when compared with the other (non-symptom-caused) detection. Conclusion Symptoms suggestive of LC are the number one reason that led to detection in early NSCLC. They were also associated with tumor size at diagnosis, suggesting early stage LC patients are developing symptoms. Presence of symptoms in early stages did not compromise survival. Although the clincial usefulness of this information is not determined and the results need to be verified by other independent preferably prospective studies, our data indicates that the general belief on asymptomatic early stage LC may have to be reconsidered. A symptom-based alerting system or guidelines may be worth of further study to benefit for NSCLC high risk individuals.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4449. doi:1538-7445.AM2012-4449