In a German study (HANSE) reported in The Lancet Oncology, Vogel-Claussen et al found that the PLCOm2012 low-dose computed tomography (CT) lung cancer screening eligibility criteria were more effective than the NELSON criteria in the detection of lung cancer.
Study Details
The prospective cohort multicenter study included current or former smokers aged 55 to 79 years who met high-risk criteria for lung cancer defined by the NELSON selection criteria or by a PLCOm2012 6-year risk threshold of at least 1.58%. Between July 2021 and August 2022, 5,191 participants were enrolled (97.8% European White), including 4,167 PLCOm2012-selected participants and 3,916 NELSON-selected participants; the PLCOm2012 cutoff of at least 1.58% was predefined and estimated to result in a group size equal to that using NELSON inclusion criteria. The primary outcome measure was the positive predictive value for lung cancer detection in PLCOm2012-selected vs NELSON-selected groups.
Key Findings
All participants underwent baseline screening. Between baseline and subsequent screening (median interval of 1.05 years), 111 lung cancers were detected. Of these, 85 (76.6%) were in situ, stage I, or stage II.
Overall, among the 111 cancers detected, 108 (97.3%) were in the PLCOm2012-selected group and 85 (76.6%) were in the NELSON-selected group (P < .0001).
The positive predictive value for detection was 108 of 4,167 participants (2.59%, 95% confidence interval [CI] = 2.13%–3.12%) in the PLCOm2012-selected group vs 85 of 3,916 participants (2.17%, 95% CI = 1.74%–2.68%) in the NELSON-selected group (P = .0016). The number needed to screen to detect a lung cancer case was 38.6 (95% CI = 32.1–46.9) in the PLCOm2012-selected group vs 46.1 (95% CI = 37.3–57.5) in the NELSON-selected group.
The investigators concluded: “Participant selection using the PLCOm2012 risk prediction model with a 6-year risk of at least 1.58% cutoff is more efficient and effective in detecting lung cancer than the NELSON criteria and should therefore be implemented in lung cancer screening programs.”
Jens Vogel-Claussen, MD, of the Department of Radiology, Charité Universitätsmedizin Berlin, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Federal Ministry of Education and Research (German Center for Lung Research) and AstraZeneca. For full disclosures of all study authors, visit thelancet.com.
