Clinical outcomes after implementation of a lung nodule surveillance programme in Hong Kong.

Introduction: To facilitate early and accurate identification and risk stratification of lung nodules, a surveillance programme was implemented at a tertiary hospital in Hong Kong. This study examined the clinical outcomes of patients recruited during the first year of programme implementation.

Methods: This prospective cohort study included patients enrolled in the lung nodule surveillance programme between 1 January 2022 and 31 December 2022. Recruitment criteria included patients attending the respiratory outpatient clinic for lung nodules or lung masses. Patient demographics and clinical outcomes were analysed. Primary outcomes were the number of lung cancer cases detected and their stage at diagnosis. Secondary outcomes included the invasive investigations performed, adverse events related to these procedures, and details of lung cancer treatment and survival.

Results: Of the 1471 patients recruited to the programme, 291 (19.8%) underwent invasive investigations, and 133 (9.0%) were diagnosed with lung cancer. Among those diagnosed, 62 (46.6%) had stage I disease and 10 (7.5%) had stage II disease. Overdue scans and missed follow-ups were identified and rescheduled. Significantly better survival was observed in female patients compared with male patients (P=0.037 for progression-free survival and P=0.030 for overall survival), and in patients with early-stage cancer compared with those with late-stage lung cancer (P<0.001). Age was also independently associated with survival outcomes (P<0.001).

Conclusion: The implementation of a lung nodule surveillance programme resulted in the detection of early-stage lung cancer in more than half of diagnosed cases, with the potential to improve patient survival.