. 2021 Sep 11:10:100179.

doi: 10.1016/j.lanepe.2021.100179. eCollection 2021 Nov.

Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis

John K Field¹, Daniel Vulkan², Michael P A Davies¹, David R Baldwin³, Kate E Brain⁴, Anand Devaraj⁵, Tim Eisen⁶, John Gosney⁷, Beverley A Green¹, John A Holemans⁸, Terry Kavanagh⁹, Keith M Kerr¹⁰, Martin Ledson¹¹, Kate J Lifford⁴, Fiona E McRonald¹, Arjun Nair¹², Richard D Page¹³, Mahesh K B Parmar¹⁴, Doris M Rassl¹⁵, Robert C Rintoul¹⁶, Nicholas J Screaton¹⁶, Nicholas J Wald¹⁷, David Weller¹⁸, David K Whynes¹⁹, Paula R Williamson²⁰, Gasham Yadegarfar¹, Rhian Gabe²¹, Stephen W Duffy²

Affiliations

¹ Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK.
² Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
³ Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.
⁴ Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
⁵ Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK.
⁶ Department of Oncology, University of Cambridge, Cambridge, UK.
⁷ Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
⁸ Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
⁹ Lung Cancer Patient Advocate, Liverpool, UK.
¹⁰ Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK.
¹¹ Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹² Department of Radiology, University College, London Hospital, London, UK.
¹³ Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹⁴ MRC Clinical Trials Unit, University College London, London, UK.
¹⁵ Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
¹⁶ Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
¹⁷ Faculty of Population Health Sciences, University College London, London, UK.
¹⁸ School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK.
¹⁹ School of Economics, University of Nottingham, Nottingham, UK.
²⁰ Department of Biostatistics, University of Liverpool, Liverpool, UK.
²¹ Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK.

PMID: 34806061
PMCID: PMC8589726
DOI: 10.1016/j.lanepe.2021.100179

Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis

John K Field et al. Lancet Reg Health Eur. 2021.

. 2021 Sep 11:10:100179.

doi: 10.1016/j.lanepe.2021.100179. eCollection 2021 Nov.

Authors

Affiliations

¹ Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK.
² Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
³ Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.
⁴ Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
⁵ Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK.
⁶ Department of Oncology, University of Cambridge, Cambridge, UK.
⁷ Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
⁸ Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
⁹ Lung Cancer Patient Advocate, Liverpool, UK.
¹⁰ Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK.
¹¹ Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹² Department of Radiology, University College, London Hospital, London, UK.
¹³ Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹⁴ MRC Clinical Trials Unit, University College London, London, UK.
¹⁵ Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
¹⁶ Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
¹⁷ Faculty of Population Health Sciences, University College London, London, UK.
¹⁸ School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK.
¹⁹ School of Economics, University of Nottingham, Nottingham, UK.
²⁰ Department of Biostatistics, University of Liverpool, Liverpool, UK.
²¹ Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK.

PMID: 34806061
PMCID: PMC8589726
DOI: 10.1016/j.lanepe.2021.100179

Abstract

Background: The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial.

Methods: From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence.

Findings: 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials.

Interpretation: The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups.

Funding: NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.

Keywords: CT Screening; Lung Cancer; Lung Cancer Mortality; Meta-analysis.

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Conflict of interest statement

JKF has received fees from AstraZeneca (Speaker's Bureau) and advisory boards of Epigenomics; NUCLEIX Ltd. AstraZeneca, iDNA; Grant Support: Janssen Research & Development, LLC. RCR is on the advisory boards of AstraZeneca and Roche. DRB has received speaker remuneration from AstraZeneca, Roche, MSD, BMS, Johnson and Johnson. KB has received personal fees from Astra Zeneca outside the submitted work. TE receives research support from AstraZeneca, Bayer, Pfizer; is employed by Roche (from March 2020) and was employed by AstraZeneca (to March 2020) and has stock in AstraZeneca and Roche; is a trustee of Macmillan Cancer Support. AN has current grants and contracts with BRC, DART; Honoraria Aidence BV, AstraZeneca; Support from BLF, and as the clinical lead for NTLHC. No competing interests from all other co-authors.

Figures

Fig. 2. — **Fig. 2**
Cumulative mortality from lung cancer.

Fig. 3. — **Fig. 3**
Cumulative incidence of lung cancer.

Fig. 4. — **Fig. 4**
Cumulative mortality from all causes (participants diagnosed with lung cancer).

Fig. 5. — **Fig. 5**
Cumulative incidence of late stage lung cancer.

Fig. 6. — **Fig. 6**
Cumulative incidence of lung cancer by nodule classification category (screening arm only, excluding screen-detected cancers).

Fig. 7. — **Fig. 7**
Forest plot, lung cancer mortality.

Fig. 8. — **Fig. 8**
Forest plot, mortality from all causes.

See this image and copyright information in PMC

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Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis

Affiliations

Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

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