Airflow Limitation and Histology Shift in the National Lung Screening Trial The NLST-ACRIN Cohort Substudy
Airflow Limitation and Histology Shift in the National Lung Screening Trial The NLST-ACRIN Cohort Substudy
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DOI：
10.1164/rccm.201505-0894oc
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发表时间：
2015-11-01
影响因子：
24.7
通讯作者：
Aberle, Denise
中科院分区：
文献类型：
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作者：
Young, Robert P.;Duan, Fenghai;Aberle, Denise
理由：在美国，每年一次计算机断层扫描 (CT) 现在被广泛推荐用于肺癌筛查，尽管人们仍然担心其潜在危害，包括过度诊断带来的危害。 目的：通过比较国家肺部筛查试验 (NLST) 亚组中的肺癌发病率、组织学和分期变化，检查气流限制对过度诊断的影响。方法：在 NLST 亚组中（n = 18,714），筛查参与者被随机每年接受计算机断层扫描（CT，n = 9,357）或胸部X光检查（n = 9,357）筛查，并监测平均6.1年。在基线前支气管扩张肺量测定后，为了确定是否存在气流受限，18,475 名受试者 (99%) 被分配为患有慢性阻塞性肺疾病 (COPD) 或无慢性阻塞性肺病。按 COPD 分层后比较肺癌患病率、发病率、组织学和分期变化。测量和主要结果：对于肺活量 COPD 筛查参与者 (n = 6,436)，肺癌发病率增加了一倍（发病率比，2.15；P < 0.001），并且根据筛查组进行比较时，没有多余的肺癌和可比较的组织学。与胸部X光检查相比，CT组中晚期癌症的发生率也呈下降趋势（P = 0.054）。对于那些基线肺量测定正常的人 (n = 12,039)，我们在 CT 组筛查期间发现了过量的肺癌，几乎全部是早期腺癌相关癌症（组织学转变和过度诊断）。对这些多余的癌症进行校正后，分期转移是微乎其微的（P = 0.077）。结论：在 NLST-ACRIN（美国放射成像网络学院）队列的 CT 组中，COPD 状态与肺癌发病率加倍相关，没有明显的过度诊断，并且分期转移更有利。
Rationale: Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis.Objectives: To examine the effect of airflow limitation on overdiagnosis by comparing lung cancer incidence, histology, and stage shift in a subgroup of the National Lung Screening Trial (NLST).Methods: In an NLST subgroup (n = 18,714), screening participants were randomized to annual computed tomography (CT, n = 9,357) or chest radiograph (n = 9,357) screening and monitored for a mean of 6.1 years. After baseline prebronchodilator spirometry, to identify the presence of airflow limitation, 18,475 subjects (99%) were assigned as having chronic obstructive pulmonary disease (COPD) or no COPD. Lung cancer prevalence, incidence, histology, and stage shift were compared after stratification by COPD.Measurements and Main Results: For screening participants with spirometric COPD (n = 6,436), there was a twofold increase in lung cancer incidence (incident rate ratio, 2.15; P < 0.001) and, when compared according to screening arm, no excess lung cancers and comparable histology. Compared with chest radiography, there was also a trend favoring reduced late-stage and increased early-stage cancers in the CT arm (P = 0.054). For those with normal baseline spirometry (n = 12,039), we found an excess of lung cancers during screening in the CT arm, almost exclusively early-stage adenocarcinoma-related cancers (histology shift and overdiagnosis). After correction for these excess cancers, stage shift was marginal (P = 0.077).Conclusions: In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.