Clinical outcomes after implementation of a lung nodule surveillance programme in Hong Kong

Abstract

<p><strong>Introduction:</strong> To facilitate early and accurate identification and risk stratification of lung nodules, a surveillance programme was implemented at a tertiary hospital in Hong Kong. This study examined the clinical outcomes of patients recruited during the first year of programme implementation.<br></p><p><strong>Methods:</strong> This prospective cohort study included patients enrolled in the lung nodule surveillance programme between 1 January 2022 and 31 December 2022. Recruitment criteria included patients attending the respiratory outpatient clinic for lung nodules or lung masses. Patient demographics and clinical outcomes were analysed. Primary outcomes were the number of lung cancer cases detected and their stage at diagnosis. Secondary outcomes included the invasive investigations performed, adverse events related to these procedures, and details of lung cancer treatment and survival.<br></p><p><strong>Results:</strong> Of the 1471 patients recruited to the programme, 291 (19.8%) underwent invasive investigations, and 133 (9.0%) were diagnosed with lung cancer. Among those diagnosed, 62 (46.6%) had stage I disease and 10 (7.5%) had stage II disease. Overdue scans and missed follow-ups were identified and rescheduled. Significantly better survival was observed in female patients compared with male patients (P=0.037 for progression-free survival and P=0.030 for overall survival), and in patients with early-stage cancer compared with those with late-stage lung cancer (P<0.001). Age was also independently associated with survival outcomes (P<0.001).<br></p><p><strong>Conclusion:</strong> The implementation of a lung nodule surveillance programme resulted in the detection of early-stage lung cancer in more than half of diagnosed cases, with the potential to improve patient survival.</p>

引言：為了及早和準確發現肺部結節，並評估其惡化風險，香港一所 大型公立醫院推行了一項肺結節監測計劃。本研究旨在評估該計劃實 施首年內參與患者的臨床結果。 方法：這項前瞻性隊列研究納入於2022年1月1日至12月31日期間參 加肺結節監測計劃的患者，招募對象為到呼吸科專科門診接受肺結節 或肺部腫塊評估的患者。研究分析了患者的人口學特徵及臨床結果， 主要研究結果包括確診的肺癌病例數及其確診時的分期；次要研究結 果則包括侵入性檢查、與這些檢查相關的不良事件，以及肺癌的治療 方式與存活情況。 結果：在參加肺結節監測計劃的1471名患者中，291人（19.8%）接 受了侵入性檢查，當中133人（9.0%）確診為肺癌。在這133名肺癌 患者中，62人（46.6%）在第I期被確診，10人（7.5%）在第II期被 確診。研究期間發現部分患者的影像檢查逾期或未如期覆診，已安排 重新追蹤。女性患者的無惡化存活期與總體存活率明顯優於男性患者 （無惡化存活期 P=0.037；總體存活率 P=0.030）。此外，早期肺癌 患者的存活情況亦顯著較晚期肺癌患者為佳（P<0.001）。年齡與患 者的存活結果有獨立相關性（P<0.001）。 結論：肺結節監測計劃使超過一半確診個案能在肺癌早期被發現，顯 示該計劃具潛力改善患者的存活率。