Evidence map›Paper›PMID 39798695›Full record

ArticleJournal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer2025

Impact of Comorbidities on the Mortality Benefits of Lung Cancer Screening: A Post-Hoc Analysis of the PLCO and NLST Trials.

Sebastien Gendarme, Ehsan Irajizad, James P Long, Johannes F Fahrmann, Jennifer B Dennison, Seyyed Mahmood Ghasemi, Rongzhang Dou, Robert J Volk, Rafael Meza, Iakovos Toumazis and 3 more

Abstract read
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In one paragraph

Article in Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Sebastien GendarmeDepartment of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas; Université Paris-Est-Créteil, Inserm, IMRB, Créteil, France. Electronic address: sebastien.gendarme@u-pec.fr.
Ehsan IrajizadDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
James P LongDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Johannes F FahrmannDepartment of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jennifer B DennisonDepartment of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Seyyed Mahmood GhasemiDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Rongzhang DouDepartment of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Robert J VolkDepartment of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Rafael MezaDepartment of Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada.
Iakovos ToumazisDepartment of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Florence Canoui-PoitrineUniversité Paris-Est-Créteil, Inserm, IMRB, Créteil, France; APHP, Mondor Teaching Hospital, Department of Public Health, Creteil, France.
Samir M HanashDepartment of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Edwin J OstrinDepartment of General Internal Medicine and Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI DIANE BODURKA · 1985 to 2026
$290.8M
Convalescent Plasma to Limit Coronavirus Associated ComplicationsUL1TR003167 · NCATS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI KARP, DANIEL D, MCPHERSON, DAVID D · 2019 to 2023
$45.3M
Research Project 3: Modeling the Impact of Tobacco Control Policies on Polytobacco Use and Associated Health DisparitiesU54CA229974 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Abigail S. Friedman · 2018 to 2026
$39.2M
Comparative Modeling of Lung Cancer Prevention, Early Detection and Treatment InterventionsU01CA253858 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI DE KONING, HARRY J, HOLFORD, THEODORE R · 2020 to 2025
$8.4M
Clinical Validation Center for Lung Cancer Early DetectionU01CA271888 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI HANASH, SAMIR M · 2022 to 2025
$4.9M
NCATS NIH HHS UL1 TR003167NCI NIH HHS P30 CA016672NCI NIH HHS U01 CA253858NCI NIH HHS U01 CA271888NCI NIH HHS U54 CA229974
6 · The paper itself

Abstract

objectivesTo evaluate how comorbidities affect mortality benefits of lung cancer screening (LCS) with low-dose computed tomography.

methodsWe developed a comorbidity index (Prostate, Lung, Colorectal, and Ovarian comorbidity index [PLCO-ci]) using LCS-eligible participants' data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial (training set) and the National Lung Screening Trial (NLST) (validation set). PLCO-ci predicts five-year non-lung cancer (LC) mortality using a regularized Cox model; with performance evaluated using the area under the receiver operating characteristics curve. In NLST, LC mortality (per original publication) was compared between low-dose computed tomography and chest radiograph arms across the PLCO-ci quintile (Q1-5) using a cause-specific hazard ratio (csHR) with 95% confidence intervals (CIs).

resultsAnalyses included 34,690 PLCO and 53,452 NLST participants (mean age: 62 y [±5 y] and 61 y [±5 y], 58% and 59% male individuals, and 39% and 41% active smokers, respectively). PLCO-ci predicted five-year non-LC mortality with an area under the receiver operating characteristics curve of 0.72 (95% CI: 0.71-0.74) in PLCO and 0.69 (95% CI: 0.67-0.70) in NLST. In NLST, at a median follow-up of 6.5 years, LC mortality was significantly reduced for participants with intermediate comorbidity (Q2, Q3, and Q4): csHR 0.62 (95% CI: 0.41-0.95), 0.68 (95% CI: 0.48-0.96), and 0.72 (95% CI: 0.54-0.96) respectively, with a nonstatistically significant reduction for Q1 (csHR = 0.72, 95% CI: 0.45-1.17) and no reduction for Q5 participants (csHR = 0.99, 95% CI: 0.79-1.23). Participants in Q2, Q3, and Q4 (60%) accounted for 89% of LC deaths averted among all NLST participants. Q1 participants had low LC incidence, whereas Q5 had higher localized LC lethality, more squamous cell carcinomas, and untreated LC.

conclusionsThe PLCO-ci developed in this work shows that individuals with intermediate comorbidity benefited the most from LCS, highlighting the need of addressing comorbidities to achieve LC mortality benefits.

Indexed as

Early Detection of CancerLung NeoplasmsAgedComorbidityFemaleHumansMaleMiddle AgedSurvival RateTomography, X-Ray ComputedComorbidityEarly detection of cancerLung neoplasmsShared decision makingTomography

Identifiers

PMID39798695
PMCPMC12066220

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.