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Twenty-Year Follow-Up of Lung Cancer Screening by CT
The International Early Lung Cancer Action Project (I-ELCAP) is a nonrandomized study in which smokers were screened with annual low-dose computed tomography (CT). The study began in 1992, and in a previous report, estimated lung cancer–specific 10-year survival was 80% among participants diagnosed with lung cancer (NEJM JW Oncol Hematol Feb 2007 and N Engl J Med 2006; 355:1763).
Now, the researchers have reported even longer follow-up. Lung cancer was diagnosed in 1.4% of 89,000 participants (median age, 66; median smoking history, 43 pack-years), and 81% of those cases were clinical stage 1. Estimated 10-year and 20-year lung cancer–specific survival were both 81%. In the subgroup with pathologic stage T1aN0M0, 20-year lung cancer–specific survival was 95%.
Comment
These findings are worth sharing with patients in whom CT screening detects early-stage lung cancer. The 81% lung cancer–specific survival seen at 10 years was maintained during a second decade of follow-up, suggesting that most screen-detected, treated patients had long-term cure. Smoking cessation in treated patients might partially explain this outcome (by lowering risk for later-onset, second cancers). Although this study has the usual limitations of observational screening studies (e.g., lead-time and length-time biases; overdiagnosis), the results largely align with findings from randomized trials, and the extended follow-up is the longest reported for any cohort of CT-screened smokers.
Citation(s)
Author:
Henschke CI et al.
Title:
A 20-year follow-up of the International Early Lung Cancer Action Program (I-ELCAP).
Source:
Radiology
2023
Nov
; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Allan S. Brett, MD