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IntroductionSurgery is the standard of care for early-stage lung cancer, with stereotactic ablative body radiotherapy (SABR) a lower morbidity alternative for patients with limited physiological reserve. Comparisons of outcomes between these treatment options are limited by competing comorbidities and differences in pre-treatment pathological information. This study aims to address these issues by assessing both overall and cancer-specific survival for presumed stage I lung cancer on an intention-to-treat basis.MethodsThis retrospective intention-to-treat analysis identified all patients treated for presumed stage I lung cancer within a single large UK centre. Overall survival, cancer-specific survival, and combined cancer and treatment-related survival were assessed with adjustment for confounding variables using Cox proportional hazards and Fine–Gray competing risks analyses.Results468 patients (including 316 surgery and 99 SABR) were included in the study population. Compared with surgery, SABR was associated with inferior overall survival on multivariable Cox modelling (SABR HR 1.84 (95% CI 1.32–2.57)), but there was no difference in cancer-specific survival (SABR HR 1.47 (95% CI 0.80–2.69)) or combined cancer and treatment-related survival (SABR HR 1.27 (95% CI 0.74–2.17)). Combined cancer and treatment-related death was no different between SABR and surgery on Fine–Gray competing risks multivariable modelling (subdistribution hazard 1.03 (95% CI 0.59–1.81)). Non-cancer-related death was significantly higher in SABR than surgery (subdistribution hazard 2.16 (95% CI 1.41–3.32)).ConclusionIn this analysis, no difference in cancer-specific survival was observed between SABR and surgery. Further work is needed to define predictors of outcome and help inform treatment decisions.

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The US National Lung Screening Trial (NLST) identified persons for lung cancer screening by age (55–74 yrs) and smoking history, but a subsequent analysis of the US SEER database showed that only 26.7% of lung cancer cases would have been eligible for screening according to these criteria.Strategies to increase the proportion of lung cancer patients who might qualify for screening include increasing the upper age limit to 80 years (endorsed by the US Preventative Services Task Force – USPSTF), and using composite lung cancer risk prediction tools. The UK Lung Screening pilot (UKLS) used the Liverpool Lung Project score (LLP) to identify patients for screening. In a validation cohort from the US Prostate, Lung, Colorectal and Ovarian study, a threshold based on the PLCOM2012 score identified more cancers than the NLST criteria. We prospectively compared these criteria for the first time in patients presenting with lung cancer in Yorkshire.MethodsWe audited the proportion of patients presenting with lung cancer through fast-track clinics at 4 Yorkshire centres who would have been eligible for screening according to the following criteria: NLST criteria, UKLS criteria, USPSTF criteria, LLP ≥5% 55–80 yrs, and PLCO ≥1.51% 55–80 yrs.ResultsData was collected for 206 patients presenting between January and July 2016 (Leeds 131, Halifax 26, Bradford 12, Mid-Yorkshire 37). Median age was 72 years and the proportion of cases by age cohort was as follows: <55 yrs 9.2%, 55–60 yrs 9.7%, 61–65 yrs 12.1%, 66–70 yrs 13.6%, 71–75 yrs 18.4%, 76–80 yrs 17.0%, >80 yrs 19.9%. Smoking status was: current smoker 89 (43.2%), ex-smoker 106 (51.5%) and never smoker 11 (5.3%). The number of patients eligible by the various criteria are shown in Table 1.ConclusionThe proportion of lung cancer patients who would have been eligible for screening differs considerably between the various criteria. Only approximately one third of patients would have been eligible according to the criteria used in NLST and UKLS. Increasing the upper age limit for screening to 80yrs substantially increases the proportion of cases that would be eligible. A threshold of 1.51% by the PLCOM2012 score included the largest number of lung cancer patients of the criteria assessed.Abstract S129 Table 1The numbers and proportions of lung cancer patients who would have been eligible for CT screening according to various inclusion criteriaCriteriaDescriptorNumber of eligible patientsProportion of all lung cancer patientsProportion of 55–80yrs ever-smoking patientsNLSTAge 55–74, ≥30 pack years smoking, quit time <15 years7134.5%51.1%USPSTFAge 55–80, ≥30 pack years smoking, quit time <15 years8943.2%64.0%UKLSAge 50–75, ≥5% lung cancer risk by LLPv.26732.5%48.2%PLCO ≥1.51%Age 55–80, ≥1.51% lung cancer risk by PLCOM201211153.9%79.9%LLP ≥5%Age 55–80, ≥5% lung cancer risk by LLPv.29445.6%67.6%

IntroductionIncorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described.MethodsParticipants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated to the general practitioner (GP), and those with unexplained symptomatic airflow obstruction (AO) fulfilling agreed criteria were referred to the Leeds Community Respiratory Team (CRT) for assessment and treatment. Primary care records were reviewed to determine changes to diagnostic coding and pharmacotherapy.ResultsOf 2391 LHC participants undergoing prebronchodilator spirometry, 201 (8.4%) fulfilled the CRT referral criteria of which 151 were invited for further assessment. Ninety seven participants were subsequently reviewed by the CRT, 46 declined assessment and 8 had already been seen by their GP at the time of CRT contact. Overall 70 participants had postbronchodilator spirometry checked, of whom 20 (29%) did not have AO. Considering the whole cohort referred to the CRT (but excluding those without AO postbronchodilation), 59 had a new GP COPD code, 56 commenced new pharmacotherapy and 5 were underwent pulmonary rehabilitation (comprising 2.5%, 2.3% and 0.2% of the 2391 participants undergoing LHC spirometry).ConclusionsDelivering spirometry alongside lung cancer screening may facilitate earlier diagnosis of COPD. However, this study highlights the importance of confirming AO by postbronchodilator spirometry prior to diagnosing and treating patients with COPD and illustrates some downstream challenges in acting on spirometry collected during an LHC.