Impact of lung cancer discovery mode on cancer outcomes: data from the KBP-2020-CPHG study.

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Early-stage detection significantly improves prognosis, but most diagnoses are made at advanced stages due to limited early symptoms. This real-world study from the KBP-2020-CPHG cohort evaluated clinical characteristics and overall survival according to the mode of lung cancer discovery. Patients and methods: KBP-2020-CPHG is a nationwide prospective cohort of 8999 patients with newly diagnosed lung cancer in non-academic French hospitals. Patients were categorised by mode of lung cancer discovery as symptomatic presentation, incidental finding or individual screening. Baseline characteristics and survival were compared across groups. Results: Among 8943 patients with available data, 6404 (71.6%) were diagnosed symptomatically, 2178 (24.4%) incidentally and 361 (4.0%) through opportunistic screening in a non-organised context. Overall, 71.0%, 82.5% and 89.1% of patients, respectively, had performance status 0/1 (p<0.0001), and 3.4%, 6.4% and 6.9% had lepidic adenocarcinoma (p<0.001). Early-stage disease (stages 0-II) was diagnosed in 54.6% of screened patients, 40.5% of incidentally diagnosed patients and just 10.6% of symptomatically diagnosed patients (p<0.0001). Median overall survival was 45.6, 30.0 and 11.5 months, respectively. Corresponding 3-year overall survival rates were 59.0%, 46.3% and 26.4%. Conclusion: The mode of lung cancer discovery was associated with stage at diagnosis and survival. Compared with symptomatic diagnosis, screening and incidental detection were associated with earlier stage of diagnosis and significantly better overall survival. These findings support the broader implementation of structured early-detection strategies, including screening programs, to improve the prognosis of patients with lung cancer.