HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program

Kerpel-Fronius, Anna and Megyesfalvi, Zsolt and Markóczy, Zsolt and Solymosi, Diana and Csányi, Péter and Tisza, Judit and Kecskés, Anita and Baranyi, Beatrix and Csánky, Eszter and Dóka, Adrienn and Gálffy, Gabriella and Göcző, Katalin and Győry, Csilla and Horváth, Zsolt and Juhász, Tünde and Kállai, Árpád and Kincses, Zsigmond T. and Király, Zsolt and Király-Incze, Enikő and Kostyál, László and Kovács, Anita and Kovács, András and Kuczkó, Éva and Makra, Zsuzsanna and Maurovich Horvát, Pál and Merth, Gabriella and Moldoványi, István and Müller, Veronika and Pápai-Székely, Zsolt and Papp, Dávid and Polgár, Csaba and Rózsa, Péter and Sárosi, Veronika and Szalai, Zsuzsanna and Székely, András and Szuhács, Marianna and Tárnoki, Dávid and Tavaszi, Gábor and Turóczi-Kirizs, Róbert and Tóth, László and Urbán, László and Vaskó, Attila and Vigh, Éva and Dome, Balazs and Bogos, Krisztina (2023) HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. European Radiology, 34 (5). pp. 3462-3470. ISSN 1432-1084

Text Kerpel-Fronius and Megyesfalvi et al. - Eur Rad.pdf - Published Version Restricted to Repository staff only Download (1MB) | Request a copy

Abstract

Objectives: The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. Methods: A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. Results: The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology’s archive or the Hungarian Cancer Registry (p < 0.001). Conclusions: HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary.

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