Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy

Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at...

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Vydané v:	Annals of oncology Ročník 30; číslo 7; s. 1162 - 1169
Hlavní autori:	Pastorino, U, Silva, M, Sestini, S, Sabia, F, Boeri, M, Cantarutti, A, Sverzellati, N, Sozzi, G, Corrao, G, Marchianò, A
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England Oxford University Press 01.07.2019
Predmet:	Aged Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - prevention & control Early Detection of Cancer - statistics & numerical data Female Follow-Up Studies Humans Italy - epidemiology Lung Neoplasms - diagnosis Lung Neoplasms - mortality Lung Neoplasms - prevention & control Male Middle Aged Prognosis Prospective Studies Small Cell Lung Carcinoma - diagnosis Small Cell Lung Carcinoma - mortality Small Cell Lung Carcinoma - prevention & control Survival Rate Italy lung cancer mortality screening early detection overdiagnosis low-dose computed tomography
ISSN:	0923-7534, 1569-8041, 1569-8041
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Shrnutí:	Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. Design The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. Results The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39–0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62–1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). Conclusions The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. ClinicalTrials.gov identifier NCT02837809.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0923-7534 1569-8041 1569-8041
DOI:	10.1093/annonc/mdz117