355P Prolonged follow-up in lung cancer screening: Case series and potential of miRNA for personalized intervals - A single center case series from the university hospital of Zurich

Background: Although the efficacy of low-dose computed tomography (LDCT) screening has been established in selected populations in Western countries, the distinct epidemiological characteristics of lung cancer (LC) in Asian suggest that the benefits of LDCT screening in non-risk-based populations warrant further investigation.Methods: This was a prospective, interventional, non-randomized controlled study.The screened cohort included eligible individuals enrolled in the Lung-Care project.The comparison cohort consisted of individuals from the same geographic region and age range who did not undergo screening and served as a naturally occurring control cohort.Mortality outcome was assessed using the Cox proportional hazards model to estimate hazard ratios (HRs) and 95% CIs.Overall survival was similarly compared between screen-detected and non-screen-detected LC cases.Subgroup analyses were conducted within screen-detected cases according to conventional LC risk factors, and survival differences were assessed using the log-rank test.Results: During a median follow-up of 7.0 years, screening was associated with a significantly lower risk of LC deaths (HR 0.45, 95%CI 0.32-0.65,P<0.001).In sexstratified analyses, screening was associated with reduced mortality in both men (HR 0.55; 95%CI 0.36-0.83,P=0.004) and women (HR 0.28; 95%CI 0.13-0.60,P<0.001).Among patients diagnosed with LC, screen-detected cases demonstrated significantly better overall survival compared with those detected in comparison cohort (HR 0.13; 95%CI 0.09-0.19,P<0.001).Within the screened cohort, individuals classified as high risk according to NCCN and Chinese guidelines had significantly poorer survival (P<0.001).Notably, heavy smoking and a history of chronic obstructive pulmonary disease were each associated with worse outcomes (P<0.001),whereas no significant associations were observed for other factors such as toxic exposures or a personal or family history of cancer.Conclusions: LDCT screening significantly reduces LC mortality in a non-risk-based population.These findings highlight the potential benefit of extending screening beyond current risk-based eligibility.Clinical trial identification: NCT04938804.