Endoscopic follow-up of low-grade precancerous bronchial lesions in high-risk patients: long-term results of the SELEPREBB randomised multicentre trial.
Eur Respir J
; 60(3)2022 09.
Article
in En
| MEDLINE
| ID: mdl-35236723
ABSTRACT
BACKGROUND:
3-9% of low-grade preinvasive bronchial lesions progress to cancer. This study assessed the usefulness of an intensive bronchoscopy surveillance strategy in patients with bronchial lesions up to moderate squamous dysplasia.METHODS:
SELEPREBB (ClinicalTrials.gov NCT00213603) was a randomised study conducted in 17 French centres. After baseline lung computed tomography (CT) and autofluorescence bronchoscopy (AFB) to exclude lung cancer and bronchial severe squamous dysplasia or carcinoma in situ (CIS), patients were assigned to standard surveillance (arm A) with CT and AFB at 36â months or to intensive surveillance (arm B) with AFB every 6â months. Further long-term data were obtained with a median follow-up of 4.7â years.RESULTS:
364 patients were randomised (A 180, B 184). 27 patients developed invasive lung cancer and two developed persistent CIS during the study, with no difference between arms (OR 0.63, 95% CI 0.20-1.96, p=0.42). Mild or moderate dysplasia at baseline bronchoscopy was a significant lung cancer risk factor both at 3â years (8 of 74 patients, OR 6.9, 95% CI 2.5-18.9, p<0.001) and at maximum follow-up (16 of 74 patients, OR 5.9, 95% CI 2.9-12.0, p<0.001). Smoking cessation was significantly associated with clearance of bronchial dysplasia on follow-up (OR 0.12, 95% CI 0.01-0.66, p=0.005) and with a reduced risk of lung cancer at 5â years (OR 0.15, 95% CI 0.003-0.99, p=0.04).CONCLUSION:
Patients with mild or moderate dysplasia are at very high risk for lung cancer at 5â years, with smoking cessation significantly reducing the risk. Whereas intensive bronchoscopy surveillance does not improve patient outcomes, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programmes.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Precancerous Conditions
/
Carcinoma, Squamous Cell
/
Lung Neoplasms
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Humans
Language:
En
Journal:
Eur Respir J
Year:
2022
Document type:
Article
Affiliation country:
Francia