Interpretation of updated NCCN clinical practice guidelines for lung cancer screening (version 2. 2022)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SI Haojie , XU Long , WANG Fang , SU Hang , SHE Yunlang , DAI Chenyang , HU Xuefei , ZHAO Deping , ZHU Yuming , ZHANG Peng , JIANG Gening ,  CHEN Chang

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P. R. China;

Corresponding author：

CHEN Chang, Email: chenthoracic@163.com

Keywords：

Lung cancer screening; NCCN guideline; interpretation of guideline

DOI：

10.7507/1007-4848.202208061

Video：

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Lung cancer is the most common cancer and the leading cause of cancer-related death in China. Early screening of lung cancer proves to be effective in improving its prognosis. The National Comprehensive Cancer Network (NCCN) has updated and released version 2, 2022 NCCN clinical practice guidelines for lung cancer screening in July, 2022. Based on high-quality clinical evidence and the latest research progress, the guidelines have developed and updated criteria for lung cancer screening which have been widely recognized by clinicians around the world. Compared with Chinese lung cancer screening guidelines, this article will interpret the updated content of the brand new 2022 NCCN screening guidelines, providing some reference for the current lung cancer screening practice in our country.

Citation： SI Haojie, XU Long, WANG Fang, SU Hang, SHE Yunlang, DAI Chenyang, HU Xuefei, ZHAO Deping, ZHU Yuming, ZHANG Peng, JIANG Gening, CHEN Chang. Interpretation of updated NCCN clinical practice guidelines for lung cancer screening (version 2. 2022). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1407-1413. doi: 10.7507/1007-4848.202208061 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
3.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
4.	Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003–15: A pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.
5.	Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): Analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
6.	Zeng H, Ran X, An L, et al. Disparities in stage at diagnosis for five common cancers in China: A multicentre, hospital-based, observational study. Lancet Public Health, 2021, 6(12): e877-e887.
7.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
8.	Infante M, Cavuto S, Lutman FR, et al. Long-term follow-up results of the DANTE trial, a randomized study of lung cancer screening with spiral computed tomography. Am J Respir Crit Care Med, 2015, 191(10): 1166-1175.
9.	Miller DL, Mayfield WR, Luu TD, et al. Community-based multidisciplinary computed tomography screening program improves lung cancer survival. Ann Thorac Surg, 2016, 101(5): 1864-1869.
10.	Horeweg N, van der Aalst CM, Thunnissen E, et al. Characteristics of lung cancers detected by computer tomography screening in the randomized NELSON trial. Am J Respir Crit Care Med, 2013, 187(8): 848-854.
11.	Becker N, Motsch E, Trotter A, et al. Lung cancer mortality reduction by LDCT screening-results from the randomized German LUSI trial. Int J Cancer, 2020, 146(6): 1503-1513.
12.	Walter JE, Heuvelmans MA, de Jong PA, et al. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: Analysis of data from the randomized, controlled NELSON trial. Lancet Oncol, 2016, 17(7): 907-916.
13.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
14.	Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med, 2013, 369(10): 920-931.
15.	赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021, 北京). 中国肿瘤, 2021, 30(2): 81-111.
16.	Chinese Prevention Medicine Association. Lung cancer screening guideline of China (T/CPMA 013-2020). Zhonghua Zhong Liu Za Zhi, 2021, 43(1): 1-7.
17.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
18.	Qian FYZ, Teng J, Wang H, et al. China Lung Cancer Screening (CLUS) Version 1.0: Mortality, Survival and Incidence Rates with Long-Term Follow-up; Proceedings of the WCLC, VIENNA, AUSTRIA, F, 2022.
19.	Pira E, Romano C, Donato F, et al. Mortality from cancer and other causes among Italian chrysotile asbestos miners. Occup Environ Med, 2017, 74(8): 558-563.
20.	Lenters V, Vermeulen R, Dogger S, et al. A meta-analysis of asbestos and lung cancer: Is better quality exposure assessment associated with steeper slopes of the exposure-response relationships? Environ Health Perspect, 2011, 119(11): 1547-1555.
21.	Thompson RE, Nelson DF, Popkin JH, et al. Case-control study of lung cancer risk from residential radon exposure in Worcester county, Massachusetts. Health Phys, 2008, 94(3): 228-241.
22.	Travis LB, Gospodarowicz M, Curtis RE, et al. Lung cancer following chemotherapy and radiotherapy for Hodgkin's disease. J Natl Cancer Inst, 2002, 94(3): 182-192.
23.	Morris LG, Sikora AG, Patel SG, et al. Second primary cancers after an index head and neck cancer: Subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol, 2011, 29(6): 739-746.
24.	Schwartz AG, Cote ML, Wenzlaff AS, et al. Chronic obstructive lung diseases and risk of non-small cell lung cancer in women. J Thorac Oncol, 2009, 4(3): 291-299.
25.	Ang L, Chan CPY, Yau WP, et al. Association between family history of lung cancer and lung cancer risk: A systematic review and meta-analysis. Lung Cancer, 2020, 148: 129-137.
26.	Henschke CI, Salvatore M, Cham M, et al. Baseline and annual repeat rounds of screening: Implications for optimal regimens of screening. Eur Radiol, 2018, 28(3): 1085-1094.
27.	Hammer MM, Eckel AL, Palazzo LL, et al. Cost-effectiveness of treatment thresholds for subsolid pulmonary nodules in CT lung cancer screening. Radiology, 2021, 300(3): 586-593.
28.	Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
29.	Detterbeck FC, Bolejack V, Arenberg DA, et al. The IASLC lung cancer staging project: Background data and proposals for the classification of lung cancer with separate tumor nodules in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(5): 681-692.
30.	de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
31.	Rampinelli C, De Marco P, Origgi D, et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: Secondary analysis of trial data and risk-benefit analysis. BMJ, 2017, 356: j347.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
3. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
4. Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003–15: A pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.
5. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): Analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
6. Zeng H, Ran X, An L, et al. Disparities in stage at diagnosis for five common cancers in China: A multicentre, hospital-based, observational study. Lancet Public Health, 2021, 6(12): e877-e887.
7. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
8. Infante M, Cavuto S, Lutman FR, et al. Long-term follow-up results of the DANTE trial, a randomized study of lung cancer screening with spiral computed tomography. Am J Respir Crit Care Med, 2015, 191(10): 1166-1175.
9. Miller DL, Mayfield WR, Luu TD, et al. Community-based multidisciplinary computed tomography screening program improves lung cancer survival. Ann Thorac Surg, 2016, 101(5): 1864-1869.
10. Horeweg N, van der Aalst CM, Thunnissen E, et al. Characteristics of lung cancers detected by computer tomography screening in the randomized NELSON trial. Am J Respir Crit Care Med, 2013, 187(8): 848-854.
11. Becker N, Motsch E, Trotter A, et al. Lung cancer mortality reduction by LDCT screening-results from the randomized German LUSI trial. Int J Cancer, 2020, 146(6): 1503-1513.
12. Walter JE, Heuvelmans MA, de Jong PA, et al. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: Analysis of data from the randomized, controlled NELSON trial. Lancet Oncol, 2016, 17(7): 907-916.
13. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
14. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med, 2013, 369(10): 920-931.
15. 赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021, 北京). 中国肿瘤, 2021, 30(2): 81-111.
16. Chinese Prevention Medicine Association. Lung cancer screening guideline of China (T/CPMA 013-2020). Zhonghua Zhong Liu Za Zhi, 2021, 43(1): 1-7.
17. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
18. Qian FYZ, Teng J, Wang H, et al. China Lung Cancer Screening (CLUS) Version 1.0: Mortality, Survival and Incidence Rates with Long-Term Follow-up; Proceedings of the WCLC, VIENNA, AUSTRIA, F, 2022.
19. Pira E, Romano C, Donato F, et al. Mortality from cancer and other causes among Italian chrysotile asbestos miners. Occup Environ Med, 2017, 74(8): 558-563.
20. Lenters V, Vermeulen R, Dogger S, et al. A meta-analysis of asbestos and lung cancer: Is better quality exposure assessment associated with steeper slopes of the exposure-response relationships? Environ Health Perspect, 2011, 119(11): 1547-1555.
21. Thompson RE, Nelson DF, Popkin JH, et al. Case-control study of lung cancer risk from residential radon exposure in Worcester county, Massachusetts. Health Phys, 2008, 94(3): 228-241.
22. Travis LB, Gospodarowicz M, Curtis RE, et al. Lung cancer following chemotherapy and radiotherapy for Hodgkin's disease. J Natl Cancer Inst, 2002, 94(3): 182-192.
23. Morris LG, Sikora AG, Patel SG, et al. Second primary cancers after an index head and neck cancer: Subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol, 2011, 29(6): 739-746.
24. Schwartz AG, Cote ML, Wenzlaff AS, et al. Chronic obstructive lung diseases and risk of non-small cell lung cancer in women. J Thorac Oncol, 2009, 4(3): 291-299.
25. Ang L, Chan CPY, Yau WP, et al. Association between family history of lung cancer and lung cancer risk: A systematic review and meta-analysis. Lung Cancer, 2020, 148: 129-137.
26. Henschke CI, Salvatore M, Cham M, et al. Baseline and annual repeat rounds of screening: Implications for optimal regimens of screening. Eur Radiol, 2018, 28(3): 1085-1094.
27. Hammer MM, Eckel AL, Palazzo LL, et al. Cost-effectiveness of treatment thresholds for subsolid pulmonary nodules in CT lung cancer screening. Radiology, 2021, 300(3): 586-593.
28. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
29. Detterbeck FC, Bolejack V, Arenberg DA, et al. The IASLC lung cancer staging project: Background data and proposals for the classification of lung cancer with separate tumor nodules in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(5): 681-692.
30. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
31. Rampinelli C, De Marco P, Origgi D, et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: Secondary analysis of trial data and risk-benefit analysis. BMJ, 2017, 356: j347.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of updated NCCN clinical practice guidelines for lung cancer screening (version 2. 2022)

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