The importance of incidental lung cancer nodules diagnosed in a population that does not meet the USPSTF criteria

<bold>Objectives:</bold> Low-dose computed tomography screening is considered most effective in individuals at high risk for lung cancer (LC). We aim to investigate the importance of incidental LC nodules diagnoses in a population that does not meet the USPSTF criteria. <bold>Methods:</bold> All patients with pulmonary nodules (PNs) were prospectively enrolled in the PNs Clinic Database of the First Affiliated Hospital of Chongqing Medical University from Jan 1st, 2019 to Dec 31th, 2023. LC nodules diagnosed pathologically and staged according to the 8th TNM staging (IASLC) were divided into the non-high risk and the high risk groups, according to the USPSTF recommends (aged 50-80ys, ≥ 20 pack-years and currently smoke or smoking cessation<15ys). The primary outcome is to compare the overall survival probability between the two groups in all LC, pure-solid and ground glass subgroups, respectively. <bold>Results:</bold> 7091 cases with PNs were consecutive enrolled, including 1876 patients with LC. In the all LC, solid and ground glass LC subgroups, 1491,545,946 cases and 190,109,73 cases in the non-high-risk group, 385,279,106 cases was in the high-risk group of original cohort and matched cohorts, respectively. There was no significant difference in the baseline characteristics of the matched cohorts between the two groups, excepting the smoking index, FEV1 and FEV1/FVC. The overall survival probability of the non-high risk group were significantly higher than that of the high-risk group in the all LC and the pure-solid subgroups (HR0.46,0.58,p<0.05). <bold>Conclusion:</bold> The patients with LC nodules which do not meet the USPSTF criteria represent a better prognosis, and should also be qualified for properly screening.