UKLS：英国肺癌筛查研究

UKLS：英国肺癌筛查研究

UK lung Cancer Screening trial (UKLS): Base line data

Authors:  John K. Field1, Anand Devaraj2, David R. Baldwin3, John Holemans4, Nicholas Screaton5, Martin Ledson4, Robert C. Rintoul5, Arjun Nair6, John R. Gosney7, Doris Rassl5, Keith M. Kerr8, Stephen Duffy9, David H. Hansell6
1University of Liverpool, Liverpool/UNITED KINGDOM, 2St George's Hospital, London/UNITED KINGDOM, 3Nottingham University Hospitals and University of Nottingham, Nottingham/UNITED KINGDOM, 4Liverpool Heart & Chest Hospital, Liverpool/UNITED KINGDOM, 5Papworth Hospital, Cambridge/UNITED KINGDOM, 6Royal Brompton Hospital, London/UNITED KINGDOM, 7Royal Liverpool University Hospital, Liverpool/UNITED KINGDOM, 8Aberdeen University Medical School, Aberdeen/UNITED KINGDOM, 9Queen Mary University of London, London/UNITED KINGDOM

Background

Lung Cancer causes over 35,000 UK deaths per year: early detection by CT screening has been shown to reduce mortality in the USA by 20%.

Methods

UKLS is a pilot randomised controlled trial, screening individuals at a high risk of developing lung cancer (>5% over 5yrs) with low-dose CT. UKLS is population-based, approaching people of 50-75yrs identified through local primary care records and using a validated lung cancer risk prediction model to identify high risk individuals from the target group (Raji Annals of Int. Med 2012). We report observations made from the initial recruitment to the trial.

250,000 individuals were approached in Liverpool and Cambridgeshire, 30% responded positively to the first questionnaire. 4000 individuals were recruited and randomised to receive either a low-dose CT scan or usual care. All CTs were double read according to UKLS protocol. Nodules were reported as category 1, 2, 3 or 4 depending on size and volume (Baldwin et al. Thorax 2011). Participants with category 4 nodules (>500mm3) were referred to the lung cancer multi-disciplinary team (MDT) for further workup. Individuals with a category 3 nodule (50-500 mm3) underwent a repeat CT within 3 months, whereas category 2 nodules (15-50mm3) were followed up at 12 months. The trial is currently in follow-up and some participants are still in the 3 and 12 month phases.

Results

1991 high risk UKLS participants underwent baseline CT by June 2013. 1044/1991(52.4%) individuals had nodules requiring further imaging or work-up. 79/1991 (4.0%) had nodules which required referral to the MDT clinics at the pilot sites for further workup. At this time 31/1991(1.6%) had a prevalent lung cancer. 27/31 lung cancers (87.1%) were non-small cell lung cancer and 25/31 lung cancers (80.6%) were Stage I or II (based on pathological staging or clinical staging where the pathology staging was not available).

Conclusion

UKLS has already demonstrated 1.6% prevalence, utilising the LLP risk prediction model to identify high risk individuals, which compares favourably with the NELSON and other European trials. The Pilot UKLS is due to provide an interim report in 2014.

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