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Comparative Study
. 2014 Jun 1;120(11):1713-24.
doi: 10.1002/cncr.28623. Epub 2014 Feb 27.

Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials

Rafael Meza  1 , Kevin ten Haaf, Chung Yin Kong, Ayca Erdogan, William C Black, Martin C Tammemagi, Sung Eun Choi, Jihyoun Jeon, Summer S Han, Vidit Munshi, Joost van Rosmalen, Paul Pinsky, Pamela M McMahon, Harry J de Koning, Eric J Feuer, William D Hazelton, Sylvia K Plevritis
Affiliations
Comparative Study

Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials

Rafael Meza et al. Cancer. .

Abstract

Background: The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography screening is an effective way of reducing lung cancer (LC) mortality. However, optimal screening strategies have not been determined to date and it is uncertain whether lighter smokers than those examined in the NLST may also benefit from screening. To address these questions, it is necessary to first develop LC natural history models that can reproduce NLST outcomes and simulate screening programs at the population level.

Methods: Five independent LC screening models were developed using common inputs and calibration targets derived from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). Imputation of missing information regarding smoking, histology, and stage of disease for a small percentage of individuals and diagnosed LCs in both trials was performed. Models were calibrated to LC incidence, mortality, or both outcomes simultaneously.

Results: Initially, all models were calibrated to the NLST and validated against PLCO. Models were found to validate well against individuals in PLCO who would have been eligible for the NLST. However, all models required further calibration to PLCO to adequately capture LC outcomes in PLCO never-smokers and light smokers. Final versions of all models produced incidence and mortality outcomes in the presence and absence of screening that were consistent with both trials.

Conclusions: The authors developed 5 distinct LC screening simulation models based on the evidence in the NLST and PLCO. The results of their analyses demonstrated that the NLST and PLCO have produced consistent results. The resulting models can be important tools to generate additional evidence to determine the effectiveness of lung cancer screening strategies using low-dose computed tomography.

Keywords: Cancer Intervention and Surveillance Modeling Network (CISNET); cancer natural history models; comparative modeling analyses; low-dose CT screening; lung cancer screening; simulation model; smoking and lung cancer.

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Conflict of interest statement

Conflicts of interest: All investigators involved report no conflicts of interest with objectively conducting this research.

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