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Tumor size can predict the survival of a patient with the most common type of lung cancer, according to physician-scientists at NewYork Weill Cornell Medical Center. The study, which is the lead paper in this month's Chest, emphasizes the need for further substaging in lung cancer and suggests the importance of early detection by CT scans.

The study evaluates the relationship between tumor size and five-year survival in patients with stage IA non-small cell lung cancer (NSCLC). Researchers reviewed the history of 244 patients treated at NewYork-Presbyterian Hospital/Weill Cornell Medical Center who underwent surgical resection for lung tumors between 1991 and 2001. Overall survival rates and survival rates specific to lung cancer were analyzed and compared to tumor size. The overall five-year survival rate for all patients was 71.1 percent, and the five-year disease-specific survival was 74.9 percent. Significantly, tumor size was an important predictor of long-term survival: disease-specific survival was 81.4 percent for patients with tumors less than or equal to 2.0 cm and only 63.4 percent for patients with tumors greater than 2.0 cm.

"These findings should encourage CT screening, which can detect tumors smaller than one centimeter," says Dr. Nasser K. Altorki, the study's principal investigator, Professor of Cardiothoracic Surgery at Weill Cornell Medical College, and Director of the Division of Thoracic Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "The message is clear: early detection of tumors means better odds of survival."

Further, because the study identifies differences in survival within stage IA, the authors call for further substaging. "We found that a tumor size difference of even one centimeter can impact survival, leading us to believe that further substaging of stage IA lung cancer is necessary to ensure patients in this stage are receiving the most effective treatment," says Dr. Altorki.

Previous studies have noted a sharp difference in survival between patients with nonmetastasized tumors less than 3 cm (stage IA) and tumors more than 3 cm in size (stage IB), but little information has been available on whether size remains an important determinant of survival in tumors less than 3 cm. The study's authors plan continued investigation of the relationship between NSCLC tumor size and survival. "Further investigation may identify a tumor-size threshold below which there is minimal or reduced risk of tumor metastases," says Dr. Altorki.

In the United States, lung cancer causes more deaths in both men and women than the next three most common cancers combined (colon cancer, 48,100 deaths; breast cancer, 40,000 deaths; and prostate, 30,200 deaths). It has been estimated that 169,400 individuals in the United States received a diagnosis of lung cancer in 2002 (90,200 men and 79,200 women), and 154,900 individuals died from the disease during that year.

The paper is co-authored by Dr. Jeffrey L. Port, Assistant Professor of Cardiothoracic Surgery at Weill Cornell Medical College and Assistant Attending Cardiothoracic Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center; Dr. Michael Kent, Weill Cornell graduate staff; Dr. Robert Korst, Assistant Professor of Cardiothoracic Surgery at Weill Cornell Medical College and Assistant Attending Cardiothoracic Surgeon at NewYork Weill Cornell; Dr. Daniel Libby, Clinical Professor of Medicine at Weill Cornell Medical College and Attending Physician at NewYork Weill Cornell; and Dr. Mark Pasmantier, Clinical Professor of Medicine at Weill Cornell Medical College and Attending Physician at NewYork Weill Cornell.

The NewYork Weill Cornell Medical Center, located in Manhattan on the Upper East Side at York Avenue and 68th Street, comprises NewYork-Presbyterian Hospital and Weill Cornell Medical College.