Endoscopic follow-up of low-grade precancerous bronchial lesions in high-risk patients: long-term results of the SELEPREBB randomised multicentre trial.

Autor:	Guisier F; Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France florian.guisier@chu-rouen.fr., Deslee G; Dept of Pneumology, CHU de Reims, Inserm UMR 1250, Université de Reims-Champagne Ardenne, Reims, France., Birembaut P; Laboratoire de Pathologie, CHU de Reims, Reims, France., Escarguel B; Dept of Pneumology, Hôpital Saint-Joseph, Marseille, France., Chapel F; Laboratoire d'Anatomie Pathologique, CHI Toulon La Seyne sur Mer, Toulon, France., Bota S; Dept of Pneumology, CHU de Rouen, Rouen, France., Métayer J; Dept of Pathology, CHU de Rouen, Rouen, France., Lachkar S; Dept of Pneumology, CHU de Rouen, Rouen, France., Capron F; Dept of Pathology, Hôpital Pitié Salepetrière, Paris, France., Homasson JP; Dept of Pneumology, Hôpital Chevilly Larue, Chevilly Larue, France., Taulelle M; Hopital Privé Les Franciscaines, Nîmes, France., Quintana M; Centre Médical de Pathologie, Nîmes, France., Raspaud C; Clinique Pasteur, Toulouse, France., Messelet D; Laboratoire d'Anatomie et Cytologie Pathologiques, Toulouse, France., Benzaquen J; Dept of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France.; Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, FHU OncoAge, CNRS UMR7284, INSERM U1081, Nice, France., Hofman P; Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, CNRS, INSERM, Nice, France.; Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, FHU OncoAge, BB-0033-00025, Centre Hospitalier Universitaire de Nice, Nice, France., Baddredine J; Laboratoire Ouest Pathologie, Rennes, France., Paris C; INSERM U1085 IRSET and Service de Santé au Travail et de Pathologie Professionnelle et Environnementale, CHRU Pontchaillou, Rennes, France., Cales V; Laboratoire d'Anatomie Pathologique, CH de Pau, Pau, France., Laurent P; Service de Pneumologie, CH François Mitterand, Pau, France., Vignaud JM; Hôpital Central, Laboratoire d'Anatomie Pathologique, Nancy, France., Ménard O; Service de Pneumologie, CHU Nancy, Hôpital Brabois, Vandoeuvre les Nancy, France., Copin MC; Institut de Pathologie, Université de Lille, CHRU Lille, Lille, France., Ramon P; Clinique des Maladies Respiratoires, CHRU Lille, Hôpital Calmette, Lille, France., Bouchindhomme B; Laboratoire d'Anatomie Pathologique, CH Lens, Lens, France., Tavernier JY; Service de Pneumologie, CH Lens, Lens, France., Quintin I; Service d'Anatomie Pathologique, CHU Brest, Hôpital Morvan, Brest, France., Quiot JJ; Service de Pneumologie, CHU Brest, Hôpital Morvan, Brest, France., Galateau-Sallé F; Laboratoire d'Anatomie Pathologique, CHU de Caen, Caen, France.; Dept of BioPathology Centre Leon Berard, Lyon, France., Zalcman G; Service de Pneumologie, CHU de Caen, Caen, France.; Thoracic Oncology Dept, Université de Paris, Hôpital Bichat Claude Bernard, Paris, France., Piton N; Service de Pathologie, Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Rouen, France., Thiberville L; Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2022 Sep 15; Vol. 60 (3). Date of Electronic Publication: 2022 Sep 15 (Print Publication: 2022).
DOI:	10.1183/13993003.01946-2021
Abstrakt:	Background: 3-9% of low-grade preinvasive 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 (ClinicalTrials.gov NCT00213603) was a randomised study conducted in 17 French centres. After baseline lung computed tomography (CT) and autofluorescence bronchoscopy (AFB) to exclude 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) with AFB every 6 months. Further long-term data were obtained with a median follow-up of 4.7 years. Results: 364 patients were randomised (A: 180, B: 184). 27 patients developed invasive lung cancer and two developed persistent CIS during the study, with no 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 of 74 patients, OR 6.9, 95% CI 2.5-18.9, p<0.001) and at maximum follow-up (16 of 74 patients, OR 5.9, 95% CI 2.9-12.0, p<0.001). 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 intensive bronchoscopy surveillance does not improve patient outcomes, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programmes. Competing Interests: Conflict of interest: All authors report payment for study completion to participating institutions from the French Ministry of Health (PHRC National). In addition, within the 36 months prior to manuscript submission: S. Lachkar reports consulting fees and payment or honoraria from Olympus, Fuji and TSC; payment or honoraria from Merck Sharp & Dohme; and participation on a data safety monitoring or advisory board for Boston Scientific. P. Hofman reports consulting fees, payment or honoraria and participation on data safety or advisory boards from AstraZeneca, Bristol Myers Squibb, Merck Sharp & Dohme, Roche, Pfizer, Bayer, Novartis, Illumina, Thermo Fisher, AbbVie, Biocartis and Lilly. G. Zalcman reports consulting fees from Bristol Myers Squibb and AstraZeneca, paid to their institution, and support for attending meetings or travel from AstraZeneca (ASCO 2019), Bristol Myers Squibb (ESMO 2018 and 2019) and AbbVie (ASCO 2019). All other authors declare no additional competing interests. (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)
Databáze:	MEDLINE
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