Endoscopic Follow-up of Low Grade Precancerous Bronchial Lesions in High-Risk Patients: long-term results of the SELEPREBB randomized multicentre trial
Abstract
Background Three to 9% of low-grade pre-invasive bronchial lesions progress to cancer. This study assessed the usefulness of an intensive bronchoscopy surveillance strategy in patients with bronchial lesions up to moderate squamous dysplasia. Methods SELEPREBB ( NCT00213603 ) was a randomized study conducted in 17 French centers. After baseline lung CT-scan and autofluorescence bronchoscopy (AFB) excluding lung cancer and bronchial severe squamous dysplasia or carcinoma in situ (CIS), patients were assigned to standard surveillance (arm A) with CT and AFB at 36 months or to intensive surveillance (arm B) including AFB every 6 months. Further long term data were obtained with a median follow-up of 4.7 years. Results 364 patients were randomized (A: 180, B: 184). Twenty-seven patients developed invasive lung cancer and 2 developed persistent CIS during the study, without difference between arms (OR=0.63, 95% CI=[0.20–1.96], p=0.42). Mild or moderate dysplasia at baseline bronchoscopy was a significant lung cancer risk factor both at 3 years (8/74 patients, OR=6.9, 95% CI=[2.5–18.9], p<0.001) and at maximum follow-up (16/74, patients, OR=5.9, 95% CI=[2.9–12.0]). Smoking cessation was significantly associated with clearance of bronchial dysplasia on follow-up (OR=0.12, 95% CI=[0.01–0.66], p=0.005) and with a reduced risk of lung cancer at 5 years (OR=0.15, 95% CI=[0.003–0.99], p=0.04). Conclusion Patients with mild or moderate dysplasia are at very high-risk for lung cancer at 5 years, with smoking cessation significantly reducing the risk. Whereas an intensive bronchoscopy surveillance does not improve patient's outcome, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programs.