Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group.

Adenocarcinoma of Lung / complications Bronchoscopy Carcinoma, Large Cell / complications Carcinoma, Non-Small-Cell Lung / complications Carcinoma, Small Cell / complications Carcinoma, Squamous Cell / complications Cytological Techniques Early Detection of Cancer / methods Female Humans Lung Neoplasms / complications Male Middle Aged Neoplasm Staging Optical Imaging Pulmonary Disease, Chronic Obstructive / complications Risk Assessment Sensitivity and Specificity Sputum / cytology Tomography, X-Ray Computed United Kingdom

Journal

The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460

Informations de publication

Date de publication:
10 2019
Historique:
received: 22 03 2019
accepted: 11 07 2019
pubmed: 21 9 2019
medline: 8 10 2020
entrez: 21 9 2019
Statut: epublish

Résumé

Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.

Sections du résumé

BACKGROUND
Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy.
METHODS
LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell).
RESULTS
1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals
CONCLUSIONS
Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.

Identifiants

DOI: 10.1183/13993003.00581-2019 PMID: 31537697 PMC: PMC6796151
pubmed: 31537697
pii: 13993003.00581-2019
doi: 10.1183/13993003.00581-2019
pmc: PMC6796151
pii:
doi:

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Cancer Research UK
ID : C5784/A17168
Pays : United Kingdom

Informations de copyright

Copyright ©ERS 2019.

Déclaration de conflit d'intérêts

Conflict of interest: S.G. Spiro has nothing to disclose. Conflict of interest: P.L. Shah has nothing to disclose. Conflict of interest: R.C. Rintoul has nothing to disclose. Conflict of interest: J. George has nothing to disclose. Conflict of interest: S. Janes reports personal fees for advisory board work from BARD1, Achilles Therapeutics and AstraZeneca, personal fees for conference travel from AstraZeneca, outside the submitted work. Conflict of interest: M. Callister has nothing to disclose. Conflict of interest: M. Novelli has nothing to disclose. Conflict of interest: P. Shaw has nothing to disclose. Conflict of interest: G. Kocjan has nothing to disclose. Conflict of interest: C. Griffiths has nothing to disclose. Conflict of interest: M. Falzon has nothing to disclose. Conflict of interest: R. Booton has nothing to disclose. Conflict of interest: N. Magee has nothing to disclose. Conflict of interest: M. Peake reports personal fees for lectures from Roche Products Ltd, grants and personal fees for lectures from MSD Ltd, personal fees for advisory board work from BMS and Pfizer Ltd, outside the submitted work. Conflict of interest: P. Dhillon has nothing to disclose. Conflict of interest: K. Sridharan has nothing to disclose. Conflict of interest: A.G. Nicholson has nothing to disclose. Conflict of interest: S. Padley has nothing to disclose. Conflict of interest: M.N. Taylor has nothing to disclose. Conflict of interest: A. Ahmed has nothing to disclose. Conflict of interest: J. Allen has nothing to disclose. Conflict of interest: Y. Ngai has nothing to disclose. Conflict of interest: N. Chinyanganya has nothing to disclose. Conflict of interest: V. Ashford-Turner has nothing to disclose. Conflict of interest: S. Lewis has nothing to disclose. Conflict of interest: D. Oukrif has nothing to disclose. Conflict of interest: P. Rabbits has nothing to disclose. Conflict of interest: N. Counsell has nothing to disclose. Conflict of interest: A. Hackshaw has nothing to disclose.

Références

Chest. 2018 Jun;153(6):1326-1335
pubmed: 29452098
J Clin Oncol. 2017 Mar 10;35(8):861-869
pubmed: 28095156
N Engl J Med. 2011 Aug 4;365(5):395-409
pubmed: 21714641
JAMA. 2012 Jun 13;307(22):2418-29
pubmed: 22610500
Eur Respir J. 2015 Jul;46(1):28-39
pubmed: 25929956
J Thorac Cardiovasc Surg. 1993 Jun;105(6):1035-40
pubmed: 8501931
PLoS Med. 2014 Dec 02;11(12):e1001764
pubmed: 25460915
Am J Respir Crit Care Med. 2015 Nov 1;192(9):1060-7
pubmed: 26199983
J Thorac Oncol. 2007 Nov;2(11):993-1000
pubmed: 17975489
Respir Med. 2013 May;107(5):702-7
pubmed: 23465176
Ann Intern Med. 2012 Aug 21;157(4):242-50
pubmed: 22910935
Respirology. 2014 Jan;19(1):98-104
pubmed: 24033868
Thorax. 2012 May;67(5):418-25
pubmed: 22106018
Eur Respir J. 2004 Apr;23(4):497-8
pubmed: 15083741
Health Technol Assess. 2016 May;20(40):1-146
pubmed: 27224642
Am J Respir Crit Care Med. 2016 Mar 1;193(5):542-51
pubmed: 26485620
Cancer Epidemiol Biomarkers Prev. 2003 Oct;12(10):987-93
pubmed: 14578133
Eur Respir J. 2005 Jun;25(6):956-63
pubmed: 15929948
Lung Cancer. 2011 Aug;73(2):183-8
pubmed: 21237526
Clin Chest Med. 2018 Mar;39(1):45-55
pubmed: 29433724
JAMA Oncol. 2017 Sep 1;3(9):1278-1281
pubmed: 28152136
Thorax. 2007 Jan;62(1):43-50
pubmed: 16825337
Respir Med. 2015 Aug;109(8):1012-8
pubmed: 26108990
Cancer. 1992 Sep 1;70(5):1102-10
pubmed: 1515985
Chest. 1991 Mar;99(3):742-3
pubmed: 1995233
N Engl J Med. 2013 Sep 5;369(10):920-31
pubmed: 24004119
Arch Intern Med. 2003 Jun 23;163(12):1475-80
pubmed: 12824098
N Engl J Med. 2009 Dec 3;361(23):2221-9
pubmed: 19955524
Anal Cell Pathol (Amst). 2012;35(3):187-201
pubmed: 22277916
Cancer. 2000 Dec 1;89(11 Suppl):2468-73
pubmed: 11147629
Ann Thorac Med. 2012 Jan;7(1):21-5
pubmed: 22347346
Eur Respir J. 2012 Oct;40(4):1063-4
pubmed: 23024333
J Clin Oncol. 1988 Nov;6(11):1685-93
pubmed: 2846790
Am J Respir Crit Care Med. 2008 Oct 1;178(7):738-44
pubmed: 18565949
Eur Respir J. 2003 Jul;22(1):1-2
pubmed: 12882441
Cochrane Database Syst Rev. 2013 Jun 21;(6):CD001991
pubmed: 23794187
Am J Respir Crit Care Med. 2012 Jan 1;185(1):85-9
pubmed: 21997335
Thorax. 2019 Apr;74(4):405-409
pubmed: 29440588
EBioMedicine. 2015 Nov;2(11):1677-85
pubmed: 26870794
Chest. 2004 May;125(5 Suppl):95S-6S
pubmed: 15136433
Cancer Control. 2003 Jul-Aug;10(4):306-14
pubmed: 12915809
J Thorac Oncol. 2011 Aug;6(8):1336-44
pubmed: 21642863
Ann Intern Med. 2013 Apr 16;158(8):635
pubmed: 23588755

Auteurs

Stephen G Spiro (SG)

Dept of Respiratory Medicine, University College Hospital, London, UK.
These authors are joint lead authors.

Pallav L Shah (PL)

Dept of Respiratory Medicine, Royal Brompton Hospital, Chelsea and Westminster Hospital and Imperial College London, London, UK.
ORCID: 0000-0002-9052-4638

Robert C Rintoul (RC)

Dept of Oncology, Royal Papworth Hospital and University of Cambridge, Cambridge, UK.

Jeremy George (J)

UCL Respiratory, Dept of Medicine, University College London, London, UK.

Samuel Janes (S)

UCL Respiratory, Dept of Medicine, University College London, London, UK.
ORCID: 0000-0002-6634-5939

Matthew Callister (M)

Dept of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Marco Novelli (M)

Cellular Pathology, University College Hospital, London, UK.

Penny Shaw (P)

Radiology (Imaging), University College Hospital, London, UK.

Gabrijela Kocjan (G)

Cellular Pathology, University College Hospital, London, UK.

Chris Griffiths (C)

Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Mary Falzon (M)

Cellular Pathology, University College Hospital, London, UK.

Richard Booton (R)

Lung Cancer and Thoracic Surgery Directorate, Manchester University NHS Trust and University of Manchester, Manchester, UK.
ORCID: 0000-0003-4512-2899

Nicholas Magee (N)

Respiratory Medicine, Belfast City Hospital, Belfast, UK.

Michael Peake (M)

Dept of Immunity, Infection and Inflammation, University of Leicester, Leicester, UK.
Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK.

Paul Dhillon (P)

Respiratory Medicine, University Hospitals Coventry and Warwickshire, Coventry, UK.

Kishore Sridharan (K)

Dept of Thoracic Medicine, Sunderland Royal Hospital, Sunderland, UK.

Andrew G Nicholson (AG)

Dept of Histopathology, Royal Brompton Hospital and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK.

Simon Padley (S)

Radiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK.

Magali N Taylor (MN)

Radiology (Imaging), University College Hospital, London, UK.

Asia Ahmed (A)

Radiology (Imaging), University College Hospital, London, UK.

Jack Allen (J)

Cancer Research UK and UCL Cancer Trials Centre, London, UK.

Yenting Ngai (Y)

Cancer Research UK and UCL Cancer Trials Centre, London, UK.

Nyasha Chinyanganya (N)

Cancer Research UK and UCL Cancer Trials Centre, London, UK.

Victoria Ashford-Turner (V)

Cardio-Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Sarah Lewis (S)

Research and Development, Royal Papworth Hospital, Cambridge, UK.

Dahmane Oukrif (D)

Dept of Pathology, University College Hospital, London, UK.

Pamela Rabbitts (P)

Leeds Institute of Cancer and Pathology (LICAP), University of Leeds, Leeds, UK.

Nicholas Counsell (N)

Cancer Research UK and UCL Cancer Trials Centre, London, UK.

Allan Hackshaw (A)

Cancer Research UK and UCL Cancer Trials Centre, London, UK.
These authors are joint lead authors.

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Classifications MeSH

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questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Carcinome à grandes cellules › Sequential screening for lung cancer in a...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › Tumeurs des bronches › Carcinome bronchogénique › Carcinome pulmonaire non à petites cellules › Sequential screening for lung cancer in a...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Carcinome à petites cellules › Sequential screening for lung cancer in a...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Tumeurs épidermoïdes › Carcinome épidermoïde › Sequential screening for lung cancer in a...
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