Lung Cancer
The NLST confirmed diagnoses of lung cancer through medical record abstraction (MRA) of participants suspected
by the trial to have lung cancer. MRA was triggered by:
- a self-report of lung cancer on a study update form (annual for LSS, semi-annual for ACRIN)
- positive CT or X-ray screening exam
- death certificate indicating lung cancer
- a relative informing screening center of participant's cancer (this was infrequent)
- suspicion of non-lung cancer that was determined (by MRA) to be lung cancer (e.g. metastasis to brain from a lung primary)
Note that if the MRA process did not find records indicating a lung cancer diagnosis,
the lung cancer was not considered confirmed, even if a source such as a death certificate indicated lung cancer.
Data collection was pursued for all lung cancers diagnosed at any time during NLST.
This included additional primary lung cancers diagnosed after the first, not just the first lung cancer per participant.
The focus of data collection was on characteristics of the cancer at the time of diagnosis.
Cancer stage was originally classified according to the AJCC 6 manual, but AJCC 7 stage data are also available from a re-review of medical records after study closeout.
The Participant dataset contains sufficient information on lung cancer diagnosis to be useful for many purposes.
Additional information is available in a separate
Lung Cancer dataset, which contains one record per primary lung cancer.
Summary |
Available Data |
- ~2050 participants were diagnosed with lung cancer during NLST
- Data are available for confirmed lung cancers, including multiple primary tumors
- Data are contained in two datasets: Participant and Lung Cancer
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Data were collected on the following forms:
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- Cancer confirmation status (confirmation, report only, no cancer, etc.)
- Days from randomization to diagnosis
- Study year of diagnosis
- ICD-O-3 code
- Histopathologic type
- Grade
- Location(s) of tumor
- Size of tumor
- Staging data
- Stage (Pathologic, Clinical, Combined; AJCC 6 and AJCC 7)
- TNM components of stage (pathologic, clinical)
- VALCSG stage (for small cell lung cancers)
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Other (Non-Lung) Cancer
In addition to lung cancer, the NLST confirmed diagnoses of non-lung cancer. This was mostly to ensure accurate
ascertainment of lung cancer status and cause of death, but the data on non-lung cancer are useful in their own
right. Less detail was collected about non-lung cancers than lung cancers.
The NLST confirmed diagnoses of non-lung cancer through medical record abstraction (MRA) of participants
suspected by the trial to have non-lung cancer. MRA was triggered by:
- a self-report of non-lung cancer on a study update form (annual for LSS, semi-annual for ACRIN)
- death certificate indicating non-lung cancer
- a relative informing screening center of participant’s cancer (this was infrequent)
- suspicion of lung cancer that was determined (by MRA) to be non-lung cancer (e.g. metastasis to lung)
Note that if the MRA process did not find records indicating a diagnosis of non-lung cancer, the cancer was not
considered confirmed, even if a source such as a death certificate indicated non-lung cancer.
Data collection was pursued for all non-lung cancers diagnosed at any time during NLST (except for basal and
squamous cell skin cancers). This included additional primary cancers of a non-lung site that were diagnosed
after the first cancer at that site.
ACRIN and LSS collected different information on non-lung cancer. ACRIN collected data on each pathology
specimen obtained during diagnostic work-up of suspected cancer, while LSS recorded data about each tumor, not
each pathology specimen. The ACRIN and LSS data were then harmonized to provide trial-wide, tumor-specific data.
This entailed summarizing the ACRIN pathology specimen data to tumor-level through a review of the data. The
trial-wide data include the ICD-O-3 code and date of diagnosis for each tumor.
The Participant dataset
contains the non-lung cancer data. Data on all cancers (lung and non-lung) are
stored in arrays of four elements, one for each confirmed cancer diagnosed during NLST, sorted by date of
diagnosis. For instance, the variables confirmed_icd_morph1-4 contain the ICD-O-3 morphology code for the first
through fourth confirmed cancers (of any site) that a participant was diagnosed with during NLST. Lung cancers are
included in the arrays to provide the sequence of all cancers diagnosed during the trial, but better information on
lung cancer is available in other variables in the participant dataset. No participant had more than four cancers
diagnosed during NLST.
Summary |
Available Data |
- ~4,800 participants were diagnosed with non-lung cancer during NLST
- Data are available for all confirmed lung cancers, including multiple primary tumors
- Data are contained in the Participant dataset
- Data are stored in arrays of up to 4 cancers (“confirmed” 1-4)
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Data were collected on the following forms:
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- Days from randomization to diagnosis
- ICD-O-3 code
- Topography
- Morphology
- Behavior
- Grade
- SEER site categorization (derived from ICD-O-3 code)
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