低剂量CT筛查开始后的分期转移与肺癌发病率

SCI

25 September 2022

Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose CT Screening

(Journal of Thoracic Oncology, IF: 20.12)

Anil Vachani, Nikki M. Carroll, Michael J. Simoff, Christine Neslund-Dudas, Stacey Honda, Robert T. Greenlee, Katharine A. Rendle, Andrea Burnett-Hartman, Debra P. Ritzwoller

CORRESPONDENCE TO: avachani@pennmedicine.upenn.edu

Introduction 简介

Despite evidence from clinical trials of favorable shifts in cancer stage and improvements in lung cancer specific mortality, the effectiveness of lung cancer screening (LCS) in clinical practice has not been clearly demonstrated.

尽管临床试验证明，癌症分期的转变和肺癌特异性死亡率的改善，但肺癌筛查（LCS）在临床实践中的有效性尚未得到明确证明。

Methods 方法

We performed a multicenter cohort study of patients diagnosed with a primary lung cancer between January 1, 2014, and September 30, 2019, at one of four US healthcare systems. The primary outcome variables were cancer stage distribution and annual age-adjusted lung cancer incidence. The primary exposure variable was receipt of at least one low-dose CT for LCS prior to cancer diagnosis.

我们在2014年1月1日至2019年9月30日期间，在美国四大医疗系统之一对诊断为原发性肺癌的患者进行了多中心队列研究。主要结果变量为癌症分期分布和年度年龄调整后肺癌发病率。主要暴露变量是在癌症诊断前接受至少一次低剂量CT进行LCS。

Results 结果

3,678 individuals were diagnosed with an incident lung cancer during the study period; 404 (11%) of these patients were diagnosed after initiation of LCS. As screening volume increased, the proportion of patients diagnosed with lung cancer after LCS initiation also rose from 0% in Q1 of 2014 to 20% in Q3 of 2019. LCS did not result in a significant change in the overall incidence of lung cancer (AAPC, -0.8 [95% CI -4.7, 3.2]) between 2014 and 2018. Stage specific incidence rates increased for Stage I cancer (AAPC, 8.0 [95% CI 0.8, 15.7]) and declined for Stage IV disease (AAPC, -6.0 [95% CI -11.2, -0.5]). 

在研究期间，3678名患者被诊断患有肺癌；这些患者中有404人（11%）在LCS开始后被诊断。随着筛查量的增加，LCS启动后诊断为肺癌的患者比例也从2014年第一季度的0%上升到2019年第三季度的20%。LCS并未导致2014年至2018年间肺癌总发病率（AAPC，-0.8 [95%CI -4.7，3.2]）发生显著变化。I期癌症的分期特异性发病率增加（AAPC，8.0[95%CI 0.8，15.7]），而IV期疾病的发病率下降（AAPC：-6.0 [95%CI-11.2，-0.5]）。

Conclusions 结论

Implementation of LCS at four diverse healthcare systems has resulted in a favorable shift to a higher incidence of Stage I cancer with an associated decline in Stage IV disease. Overall lung cancer incidence did not increase, suggesting a limited impact of over-diagnosis.

在四个不同的医疗系统中实施LCS，导致I期癌症发病率上升，IV期疾病发病率下降。总体肺癌发病率没有增加，表明过度诊断的影响有限。

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