The probability of lung cancer in patients with incidentally detected pulmonary nodules detected via low-dose computed tomography screening in China.

Abstract

10569 Background: Low dose computed tomography (LDCT) screening has been proven to be effective in reducing lung cancer mortality, but the ensuing high false-positive and overdiagnosis rates shackle the effectiveness of lung cancer screening (LCS) in China. Nodule malignancy prediction models may be an applicable solution. Methods: We developed and internally validated the model using data from the ongoing Henan province Cancer Screening Program in Urban China (CanSPUC). From 2013 to 2021, 23031 heavy smokers underwent baseline screening with LDCT; 2553 participants were diagnosed with pulmonary nodules. Detailed questionnaire, physical assessment and follow-up were completed for all participants. We then externally validated the model using the National Lung Screening Trial (NLST) dataset consisting of 10485 lung nodules in 4660 participants. Multivariable Cox proportional risk regression models were used. Data analysis was performed from July 1, 2022, through December 31, 2022. Results: A total of 111 and 1089 lung cancer cases with a median follow-up duration of 3.7 years occurred in the Henan CanSPUC and NLST study, respectively. Age, gender, physical activity, consumption of pickled food, history of silicosis or pneumoconiosis, nodule type, size, calcification, and pleural retraction sign were included into the model. The AUC (95% CI) of the model for 5-year lung cancer risk was 0.857 (0.801, 0.914) and 0.847 (0.829, 0.881) in the training set and validation set, respectively. Compared with Mayo model, VA model, PKU model, and Brock model, the Henan CanSPUC model yield statistically better discriminatory performance (all P values < 0.05). The model calibrated well across the deciles of predicted risk in both the overall population and all subgroups. Conclusions: The model developed and validated in this study may be used to estimate the probability of lung cancer in nodules detected at baseline LDCT, allowing more efficient risk-adapted follow-up in population-based LCS programs.