Lung cancer mortality reduction by LDCT screening—Results from the randomized German LUSI trial

Abstract

In 2011, the U.S. National Lung Cancer Screening Trial (NLST) reported a 20% reduction of lung cancer mortality after regular screening by low‐dose computed tomography (LDCT), as compared to X‐ray screening. The introduction of lung cancer screening programs in Europe awaits confirmation of these first findings from European trials that started in parallel with the NLST. The German Lung cancer Screening Intervention (LUSI) is a randomized trial among 4,052 long‐term smokers, 50–69 years of age, recruited from the general population, comparing five annual rounds of LDCT screening (screening arm; n = 2,029 participants) with a control arm (n = 2,023) followed by annual postal questionnaire inquiries. Data on lung cancer incidence and mortality and vital status were collected from hospitals or office‐based physicians, cancer registries, population registers and health offices. Over an average observation time of 8.8 years after randomization, the hazard ratio for lung cancer mortality was 0.74 (95% CI: 0.46–1.19; p = 0.21) among men and women combined. Modeling by sex, however showed a statistically significant reduction in lung cancer mortality among women (HR = 0.31 [95% CI: 0.10–0.96], p = 0.04), but not among men (HR = 0.94 [95% CI: 0.54–1.61], p = 0.81) screened by LDCT (pheterogeneity = 0.09). Findings from LUSI are in line with those from other trials, including NLST, that suggest a stronger reduction of lung cancer mortality after LDCT screening among women as compared to men. This heterogeneity could be the result of different relative counts of lung tumor subtypes occurring in men and women.

Lung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial

“…This study represents a timely and important update to the NLST data, alongside full results of the NELSON [7] and the LUSI trials [8], as Europe begins to set out a vision for LC screening. Although 10 years have passed since the publication of the first results of this landmark study, the USA still encounters the difficulties of implementation and the challenges of screening uptake by highrisk populations.…”

“…The NLST also supports evidence implied by the European screening trials that there is a sex difference in the benefit of LC screening in favour of females, which the NELSON trial could not fully address given most participants were male [7]. In addition, the German LUSI trial found that LDCT screening led to a statistically significant reduction in LC mortality among women (hazard ratio (HR) 0.31, p=0.04), but not among men (HR 0.94, p=0.81) [8]. This is an area that future studies will need to address to determine whether LC screening needs to be stratified by sex.…”

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

“…In over 15,000 patients with incidental nodules from a commercial insurance database, only 36% received subsequent workup despite an estimated cost of only $1-$2 per member per year when averaged across the insured population [7]. Lung cancer screening in appropriate patients has increased earlystage detection (36-71% Stage I) [8] and reduced long-term mortality rates [9][10][11][12]. However, as with incidentally detected nodules, false positive rates are high [9].…”

Diagnostische Performanz der CT für die Detektion invasiver Adenokarzinome der Lunge

“…Dies ist in der täglichen Praxis auch für die Einordnung der Noduli in die geltenden Empfehlungen der Fleischner-Society und die damit verbundenen Handlungsempfehlungen hilfreich [3]. Die prinzipiell durch die Studienautoren thematisierte Herausforderung, nämlich die klinische Einordnung (inzidenteller) Findings in der thorakalen Bildgebung, wird sicher an Relevanz gewinnen, nicht zuletzt, sollten Lungenkrebs-Screenings auch in Deutschland eingeführt werden [4].…”