Gabe Rhian, Crosbie Philip A J, Vulkan Daniel, Bailey Hannah, Baldwin David R, Bradley Claire, Booton Richard, Darby Michael J, Eckert Claire, Hancock Neil, Hinde Sebastian, Janes Sam M, Kennedy Martyn P T, Marshall Catriona, Moller Henrik, Murray Rachael L, Neal Richard D, Quaife Samantha L, Rogerson Suzanne, Shinkins Bethany, Simmonds Irene, Upperton Sara, Callister Matthew E J
Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
J Thorac Oncol. 2025 Apr;20(4):425-436. doi: 10.1016/j.jtho.2024.12.016. Epub 2024 Dec 19.
Low-dose computed tomography screening for lung cancer reduces lung cancer mortality, but there is a lack of international consensus regarding the optimal eligibility criteria for screening. The Yorkshire Lung Screening Trial was designed to evaluate lung cancer screening (LCS) implementation, and a primary objective was prospective evaluation of three predefined eligibility criteria.
Individuals who had ever smoked, aged 55 to 80 years, who responded to written invitation, underwent telephone risk assessment and if eligible by at least one criterion (PLCO ≥ 1.51%, LLP ≥ 5%, USPSTF) were offered biennial low-dose computed tomography screening.
Of 44,957 individuals invited, 22,814 responded and underwent eligibility assessment, of whom a total of 7826 were eligible according to any of the three LCS criteria. Comparing PLCO ≥ 1.51%, LLP ≥ 5%, and USPSTF, the proportions of responders eligible for screening were 28.0%, 20.5%, and 18.9%, respectively (p < 0.0001 for each comparison), and the proportion of all cancers detected 91.1%, 77.0%, and 62.8%, respectively (p ≤ 0.0002 for each comparison). When risk thresholds were selected to result in equivalent numbers of people eligible for screening, cancer detection proportions were higher for PLCO (74.5%) and LLP (71.3%) than USPSTF (62.8%) (p = 0.0002 and p = 0.032, respectively), but there was no significant difference between the two risk models. Reducing the LLPv2 risk threshold from 5% to 2.5% (as currently used in the English LCS program) and reducing the pack-year requirement for the USPSTF versus the USPSTF criteria increased the numbers eligible for screening, but subsequent cancer yield was not measured in this study.
The PLCO ≥ 1.51% criteria identified more people eligible for screening in Yorkshire Lung Screening Trial and resulted in more screen-detected lung cancers than LLP ≥ 5% or USPSTF. When compared in equivalent populations, there was no significant difference between risk models in terms of lung cancer detection and each appeared more efficient at screening population selection than USPSTF.
低剂量计算机断层扫描筛查肺癌可降低肺癌死亡率，但对于筛查的最佳资格标准缺乏国际共识。约克郡肺癌筛查试验旨在评估肺癌筛查（LCS）的实施情况，其主要目标是对三个预先定义的资格标准进行前瞻性评估。
曾经吸烟、年龄在55至80岁之间、对书面邀请做出回应的个体，接受电话风险评估，若符合至少一项标准（PLCO≥1.51%、LLP≥5%、USPSTF），则每两年接受一次低剂量计算机断层扫描筛查。
在44957名被邀请者中，22814人做出回应并接受资格评估，其中共有7826人符合三项LCS标准中的任何一项。比较PLCO≥1.51%、LLP≥5%和USPSTF，符合筛查条件的回应者比例分别为28.0%、20.5%和18.9%（每次比较p<0.0001），检测到的所有癌症比例分别为91.1%、77.0%和62.8%（每次比较p≤0.0002）。当选择风险阈值以使符合筛查条件的人数相等时，PLCO（74.5%）和LLP（71.3%）的癌症检测比例高于USPSTF（62.8%）（分别为p = 0.0002和p = 0.032），但两种风险模型之间无显著差异。将LLPv2风险阈值从5%降低到2.5%（如英国LCS计划目前所采用），以及相对于USPSTF标准降低USPSTF的包年要求，增加了符合筛查条件的人数，但本研究未测量后续的癌症检出率。
在约克郡肺癌筛查试验中，PLCO≥1.51%标准识别出更多符合筛查条件的人，且筛查出的肺癌比LLP≥5%或USPSTF更多。在同等人群中进行比较时，风险模型在肺癌检测方面无显著差异，并且在筛查人群选择方面，每种模型似乎都比USPSTF更有效。
