Autofluorescence bronchoscopy (AFB) and computed tomography (CT) enable lung cancer (LC) detection at early (pre-)invasive stage. However, LC risk in individuals harboring pre-invasive endobronchial lesions is unclear. OBJECTIVES To assess LC incidence and identify potential risk determinants in individuals harboring pre-invasive lesions.

METHODS In our tertiary care referral center, 164 individuals with pre-invasive lesions were monitored up to 12.5 years by repeated AFB and CT. Occurrence of LC was monitored. Clinical management depended on histological grade, with cancer patients receiving standard of care. Potential risk determinants (smoking status, baseline histology, cancer history and COPD-status) were evaluated in relation to cancer occurrence, event-free survival (EFS) and overall survival (OS). MEASUREMENTS AND MAIN

RESULTS During surveillance (median of 30 months, range 4-152) of 164 individuals with pre-invasive lesions (80 high-grade and 84 low-grade at inclusion), 61 LCs were detected in 55 individuals (median time-to-event 16.5 months). Twenty-three LCs (38%) were detected by CT, thirty-eight (62%) by AFB. More cancers (36/61;59%) developed from separate, rather than initial lesional sites. Individuals with high-grade lesions were more likely diagnosed with LC at the same or another site in the lungs than those with low-grade lesions (p=0.03). Independent risk determinants for OS were previous curatively treated cancer and COPD (p≤0.05).

CONCLUSIONS Presence of pre-invasive lesions, especially high-grade lesions, may serve as LC risk marker. LCs occur both at pre-invasive lesion sites and elsewhere in the bronchial epithelium or lung parenchyma. Prospective validation of biomarkers and randomized intervention studies are required to determine optimal management strategies.