Prolonged Lung Cancer Screening Reduced 10-year Mortality in the MILD Trial: New Confirmation of Lung Cancer Screening Efficacy
Mené en Italie auprès de 4 099 fumeurs âgés de 49 à 75 ans (durée de suivi : 39 293 personnes années), cet essai randomisé met en évidence l'intérêt, pour réduire la mortalité à 10 ans, de prolonger au-delà de cinq ans un programme annuel ou biennal de dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnements ionisants
Background : The National Lung Screening Trial (NLST) showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces lung cancer 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 4,099 participants, to a screening arm (n = 2,376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of six years, or control arm (n = 1,723) 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 lung cancers and deaths that occurred in the first 5 years.
Results : The LDCT arm showed a 39% reduced risk of LC mortality at 10 years (HR 0.61, 95%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 five years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction, compared to NLST trial.
ClinicalTrials.gov Identifier: NCT02837809.
Annals of Oncology , article en libre accès, 2018