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Results from the randomised UKLS trial: Lung cancer mortality reduction by LDCT screening confirmed in an international meta-analysis

Field, John K., Vulkan, Daniel, Davies, Micahel P.A., Baldwin, David R., Brain, Kate E., Devaraj, Anand, Eisen, Tim, Holemans, John A., Kavanagh, Terry, Kerr, Keith M., Ledson, Martin, Lifford, Kate J., McRonald, Fiona E., Nair, Arjun, Page, Richard D., Parmar, Mahesk K.B., Rassi, Doris M., Rintoul, Robert C., Wald, Nicolas J., Weler, David, Whynes, David K., Williamson, Paul R., Yadegarfar, Casham, Gabe, Rhian and Duffy, Stephen W. 2021. Results from the randomised UKLS trial: Lung cancer mortality reduction by LDCT screening confirmed in an international meta-analysis. The Lancet 10 , 100179. 10.1016/j.lanepe.2021.100179

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Abstract

Background The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. Methods From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50–75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. Findings 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1–7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41–1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76–0.92) from nine eligible trials. Interpretation The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. Funding NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation. Keywords Lung Cancer CT Screening Lung Cancer Mortality Meta-analysis

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Publisher: Elsevier
ISSN: 0140-6736
Date of First Compliant Deposit: 23 September 2021
Date of Acceptance: 2 July 2021
Last Modified: 09 Dec 2021 14:07
URI: https://orca.cardiff.ac.uk/id/eprint/144394

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