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Chloe Chang Su
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MA05 - Lung Cancer Screening (ID 174)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA05.08 - Impact of Low-Dose CT Screening for Primary Lung Cancer on Subsequent Risk of Brain Metastasis: Secondary Analysis of NLST (ID 3087)
11:45 - 12:45 | Presenting Author(s): Chloe Chang Su
- Abstract
- Presentation
Introduction
Brain metastasis (BrM) is one of the most common metastases from primary lung cancer (LC). Prior studies have shown that 40% of LC patients develop BrM during the course of their diseases. Recently, the National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening (vs chest X-Ray) reduces LC mortality by 20%. This has resulted in USPSTF recommendation of annual LDCT screening for individuals at high risk for LC. Despite the recent adoption of LDCT screening, it remains unknown if early detection of LC through LDCT screening may be potentially beneficial in reducing the risk of developing metastases from primary LC. Our study aimed to investigate the impact of LDCT screening for LC on the risk of developing BrM after primary LC diagnosis.
Methods
We used data from prospective population-based clinical trial data from NLST that enrolled 53,452 participants from 2002 to 2004 and followed through 2009. Our study cohort included 1,502 participants who were diagnosed with primary LC between 2002 and 2009, had available follow-up data for BrM progression, and did not present with BrM at the time of primary LC diagnosis. Our study outcome was the cumulative risk of BrM since the diagnosis of primary LC. Competing risk regression (CSR) was applied to evaluate if the cumulative risk of BrM was associated with the mode of primary LC detection—i.e. LDCT screen-detected versus non-LDCT screen-detected—in the presence of competing risks of death. The model was adjusted for potential confounding factors, including primary LC stage, histology, and age of LC diagnosis. Subgroup analyses were conducted by restricting the analysis to those with early-staged (I-III) primary LC and to those who had undergone surgery for primary LC treatment.
Results
The study cohort had a mean age of primary LC diagnosis of 65.9 ± 5.5 years, 58.7% (n=881) male, 76.8% (n=1153) in early-stage, 41.8% (n=628) with adenocarcinoma, and 55% (n=826) undergone surgery. Of 1502 participants, 41.4% (n=622) had primary LC detected through LDCT screening while 58.6% (n=880) were detected through other methods, e.g. chest X-Ray or incidental detection through clinical symptoms. The 3-year cumulative incidence of BrM in the study cohort was 9.4% (95% confidence interval (CI) 7.9%-10.9%), which varied significantly by the LC detection mode (α=0.05); the patients whose primary LC was detected with LDCT-screening had a substantially lower 3-year incidence (6.5%, 95% CI 4.5%-8.4%) versus those without (11.9%, 95% CI 9.6%-14.1%), with a cause-specific hazard ratio (cHR) of 0.54 (p=0.0018), adjusting for LC stage, histology, and age of diagnosis. This significant reduction in BrM risk among primary LC detected through LDCT-screening persisted in subgroup analyses when restricted to early-staged LC patients (cHR 0.48, p=0.002) and those who underwent surgery (cHR 0.41, p=0.0027).
Conclusion
Primary LC detected early using LDCT screening is at reduced risk of developing BrM after the diagnosis of primary LC based on a large population-based cohort study. A follow-up study is warranted to validate this finding using independent data.
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