Clinical characteristics and outcomes in participants with screen-detected clinical stage I lung cancer in the Yorkshire lung screening trial: A comparison of surgery versus stereotactic ablative radiotherapy

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BACKGROUND: Lung cancer screening with low-dose computed tomography (LDCT) saves lives by detecting early-stage curable cancer and estimates of overdiagnosis in the previous randomised studies were generally low. Screening selection criteria vary, with some programmes only recommending screening for people who are surgical candidates, whereas others make no reference to fitness for surgery. Here we report clinical characteristics and outcomes for participants in the Yorkshire Lung Screening Trial with screen-detected clinical stage I lung cancer according to treatment modality. METHODS: Consecutive participants with screen-detected clinical stage I lung cancer were stratified according to curative treatment modality into surgical and SABR cohorts. Factors associated with overall survival and cancer-specific survival were assessed with a median follow-up of 3.6 years. RESULTS: Of 190 patients with stage I lung cancer studied, 31 % (n = 58) received SABR and 69 % (n = 132) surgery (55 lobectomy, 77 sub-lobar resection). Patients treated with SABR were older with worse performance status and fitness parameters. Cancer-specific survival was similar between the SABR and surgery cohorts (HR for death 1.19, 95 % CI 0.45-3.14, p = 0.72) but overall survival was worse following SABR compared to surgery (HR for death 2.61 95 % CI 1.45-4.69, p = 0.001), indicating that the worse overall survival was due to non-cancer deaths. In the SABR cohort 17 patients (29.3 %) died from non-cancer causes during the study follow-up period compared with 9 (6.8 %) in the surgery cohort. Three-year survival was 69.4 % in the SABR cohort and 92.4 % in the surgical cohort (p < 0.001). CONCLUSIONS: Cancer-specific survival was similar between the two groups, but overall survival following SABR for screen-detected stage I lung cancer is worse than surgery due to higher rates of non-cancer death within 5 years of treatment. Lung cancer sojourn time has been estimated at around 5 years, so it is likely that rates of overdiagnosis are higher in patients treated with SABR compared to surgery. Further research may be needed to optimise inclusion and exclusion criteria for lung cancer screening.

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