1. There was no difference in median overall survival between minimal follow-up and CT-based follow-up groups.
2. Disease-free survival was not significantly different between minimal follow-up and CT-based follow-up groups.
Evidence Rating Level: 1 (Excellent)
Study Rundown: For patients with non-small-cell lung cancer (NSCLC) who meet the guidelines, the standard of care is to receive surgical resection of their tumour(s). Regardless, there is a high risk of recurrent disease and lung cancer is the primary cause of death in this population. This randomized controlled study aimed to compare the outcomes between CT-based surveillance and minimal follow-up measures post-surgical resection of NSCLC tumours. The primary outcome of interest was overall survival (OS) and secondary outcomes included disease-free survival. In the minimal follow-up group, 44.9% of patients died, compared to 42.0% of those in the CT-based group. There was no significant difference between the groups for median OS; 8.5 years for the minimal follow-up group and 10.3 years for the CT-based group. There was similarly no difference statistically between the groups for disease-free survival. There were 404 recurrences, second primary cancers, or deaths in the minimal follow-up group, compared to 440 in the CT-based group. Limitations to this study include the high proportion of patients who had stage I and I NSCLC that contributed to less OS events and reduced power of the study. Additionally, the study excluded patients who had received wedge resections, so applications of the results from this study should be considered cautiously in those patient groups. Overall, the results from this study provide evidence that the inclusion of CT scan for follow-up post surgical intervention for non-small-cell lung cancer does not improve overall survival as compared to minimal follow-up strategies that include chest x-ray.
In-Depth [ randomized controlled trial]: This open-label, phase 3, randomized controlled trial was conducted out of 122 healthcare centres in France. The study enrolled 1,775 adult patients to receive one of two follow-up options; 888 were allocated to the minimal follow-up group, consisting of chest x-ray, and 887 were allocated to receive CT-based follow-up, which included chest x-rays, thoraco-abdominal contrast-enhanced CT scan, and fibre-optic bronchoscopy. Patients had received their surgical resections within the previous 8 weeks of enrollment. The median OS for patients in the minimal follow-up group was 8.5 years (95% confidence interval (CI), 7.4-9.6 years) compared to 10.3 years (95% CI, 8.1 – not reached) for patients in the CT-based group (hazard ratio (HR) 0.95, 95% CI, 0.83-1.10). There were also no differences between 3- and 5-year OS rates between the groups. Three year OS for the minimal follow-up group was 77.2% (95% CI, 74.5-80) vs 76.1% (95% CI, 73.3-78.9) for the CT-based group. The median OS after 5 years for the minimal follow-up group was 66.8% (95% CI, 63.7-69.0) vs 65.8% (95% CI, 62.6-68.9) for the CT-based group. There was no significant difference between groups for disease-free survival; 4.9 years (95% CI, 4.3-not reached) in the CT-based group compared to median not reached (95% CI not reached-not reached) in the minimal follow-up group (adjusted HR 1.14; 95% CI, 0.99-1.30).
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