Lung nodule surveillance programme helps detect early-stage lung cancer

A lung nodule surveillance programme at Queen Mary Hospital (QMH) facilitates diagnosis of early-stage lung cancer. Data from the programme’s first year of implementation showed a higher proportion of early-stage lung cancer diagnoses compared with the Hong Kong Cancer Registry’s (HKCR) annual report.

The lung nodule surveillance programme, implemented at QMH since 2022, provides follow-up to recruited patients until the lung nodules (<3 cm) or lung masses are confirmed as benign or malignant. [Hong Kong Med J 2025;31:277-286]

Upon recruitment, nurse coordinators conduct initial screening and monitor patients’ waiting time. A clinical team comprising doctors and nurses reviews each case to risk-stratify patients, formulate investigation and follow-up plans, arrange appropriate interventions, provide patient education, and ensure timely follow-up. Nurse coordinators regularly review consultation notes, track investigation results, and reschedule overdue scans or missed follow-ups.

In a prospective cohort study, researchers from QMH and the University of Hong Kong examined clinical outcomes of 1,471 patients recruited into the programme between 1 January and 31 December 2022. Primary outcomes were the number of lung cancer cases detected and their stage at diagnosis. Secondary outcomes were invasive investigations performed, adverse events related to these procedures, and details of lung cancer treatment and survival.

A total of 291 patients (19.8 percent) underwent invasive investigations, and 133 (9.0 percent) were diagnosed with lung cancer.

“Overall, 54.1 percent of lung cancer cases were diagnosed at early stages [stages I–II], compared with 22.4 percent in HKCR’s 2021 data [p<0.001],” the researchers reported.

Among the 133 patients diagnosed with lung cancer (mean age, 69.4 years; male, 51.9 percent; nonsmokers, 60.9 percent), 62 patients (46.6 percent) had stage I disease, 10 (7.5 percent) had stage II disease, 16 (12.0 percent) had stage III disease, and 45 (33.8 percent) had stage IV disease.

“The proportion of stage I lung cancer diagnosed in the lung nodule surveillance programme was significantly higher than that reported by the HKCR in 2021 [17.4 percent; p<0.001],” the researchers highlighted. “Conversely, the proportion of stage IV cases was significantly lower in the surveillance programme compared with the HKCR data [56.9 percent; p<0.001].”

While median survival had not been reached for all patients with lung cancer as of the survival analysis in April 2024, significantly better survival was observed in female vs male patients (p=0.037 for progression-free survival and p=0.030 for overall survival), and in patients with early-stage vs late-stage disease (p<0.001). Age was also independently associated with survival outcomes (p<0.001).

However, no statistically significantly differences in survival rates were observed based on nodule characteristics or locations.

“This lung nodule surveillance programme improved follow-up compliance and facilitated timely, appropriate investigations for high-risk patients,” the researchers noted. “Overdue scans [9.0 percent] and missed follow-up appointments [23.3 percent] were promptly identified and rescheduled by programme coordinators, ensuring close monitoring and timely intervention to optimize patient outcomes.”

“Consequently, more than half of lung cancer cases were diagnosed at an early stage, enabling provision of curative treatments and potentially contributing to improved survival outcomes,” they continued.

With 60.9 percent of lung cancer cases in the study diagnosed in nonsmokers, 38.3 percent of whom were diagnosed at a late stage, the researchers emphasized that lung cancer control efforts in Hong Kong should target both smokers and nonsmokers with relevant risk factors.