Comorbidity Burden, Treatment, and Survival Among Screen-Detected Lung Cancer Patients: Implications for USPSTF Guidelines.

OBJECTIVES

Current US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening restrict low-dose chest CT (LDCT) eligibility to those willing to undergo surgery. Little is known about comorbidities, treatment, and lung cancer outcomes among LDCT-screened patients.

METHODS

This retrospective cohort study examined all patients diagnosed with lung cancer within a prospective registry of 1805 consecutive LDCT-screened patients from March 1, 2015, to March 1, 2020, in a single large health care system. We assessed baseline comorbidity burden, pulmonary function, treatment, and survival, including a prespecified focus on patients with American Joint Committee on Cancer stage I non-small cell lung cancer (NSCLC).

RESULTS

Thirty-eight patients had LDCT-detected lung cancer; median age was 69.7, median pack-years smoked was 40.0, 47.4% had emphysema, median Charlson-Deyo score was 4, and 23.7% underwent surgery. Among patients with stage I NSCLC who either received surgery (n=6) or stereotactic body radiotherapy (SBRT; n=11), a trend for surgery-treated patients to have higher performance status, higher baseline pulmonary function, and lower Charlson-Deyo score was observed. After a median follow-up of 63 months, lung cancer-specific survival was 66.7% versus 90.9% for surgery versus SBRT, while median overall survival was 82.2 versus 42.9 months (P=0.26).

CONCLUSIONS

Over three-quarters of community patients with LDCT-detected lung cancer do not receive surgery. Despite generally higher comorbidity, patients with early-stage disease receiving SBRT survived several yearsand had numerically higher lung cancer-specific survival than patients receiving surgery. Restricting LDCT screening to surgical candidates may not reflect modern outcomes.