Lung Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial
Lung Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial
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DOI：
10.1093/jnci/djq126
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发表时间：
2010-05-19
影响因子：
10.3
通讯作者：
Berg, Christine D.
中科院分区：
文献类型：
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作者：
Hocking, William G.;Hu, Ping;Berg, Christine D.
背景肺癌患者的5年总生存率约为15%。大多数患者被诊断为晚期疾病，并且生存率低于早期疾病患者。虽然肺癌筛查有可能增加早期诊断，但尚未显示出降低肺癌死亡率。在1993年，前列腺，肺，结直肠和卵巢（PLCO）癌症筛查试验，专门启动，以确定是否筛选将降低死亡率PLCO cancers.Methods共77 464名参与者，年龄在55-74岁，被随机分配到干预臂的PLCO癌症筛查试验11月8日，1993年，2001年7月2日。参与者接受了基线胸部X光片（CXR），随后在10个美国筛查中心接受了3次年度单视图CXR。根据肿瘤组织学，将癌症分为筛查检出和非筛查检出（间隔或从未筛查）。计算筛查检测癌症的阳性率和阳性预测值（PPV）。由于51.6%的参与者是目前或以前的吸烟者，因此进行了logistic回归分析以控制吸烟状况。所有统计检验均为双侧检验。结果筛选依从性从基线时的86.6%下降到末次筛选时的78.9%。总体阳性率在基线时为8.9%，在随后的筛查中为6.6%-7.1%;阳性率随着吸烟风险类别的增加而适度增加（P趋势<0.001）。所有受试者的PPV在基线时为2.0%，第1、2和3年分别为1.1%、1.5%和2.4%;当前吸烟者的PPV在基线时为5.9%，第1、2和3年分别为3.3%、4.2%和5.6%。共诊断出564例肺癌，其中306例（54%）为筛查发现的癌症，87%为非小细胞肺癌。在非小细胞肺癌，59.6%的屏幕检测到的癌症和33.3%的间隔癌症的早期（I-II）stage.Conclusions的PLCO癌症筛查试验表明，招募，保留，并在多个中心，多年来筛选大量人口的能力。筛查发现的肺癌中有更高比例是早期阶段，但关于CXR筛查有效性的结论必须等待最终的PLCO结果，预计将在2015年底得出。
Background The 5-year overall survival rate of lung cancer patients is approximately 15%. Most patients are diagnosed with advanced-stage disease and have shorter survival rates than patients with early-stage disease. Although screening for lung cancer has the potential to increase early diagnosis, it has not been shown to reduce lung cancer mortality rates. In 1993, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was initiated specifically to determine whether screening would reduce mortality rates from PLCO cancers.Methods A total of 77 464 participants, aged 55-74 years, were randomly assigned to the intervention arm of the PLCO Cancer Screening Trial between November 8, 1993, and July 2, 2001. Participants received a baseline chest radiograph (CXR), followed by three annual single-view CXRs at the 10 US screening centers. Cancers were classified as screen detected and nonscreen detected (interval or never screened) and according to tumor histology. The positivity rates of screen-detected cancers and positive predictive values (PPVs) were calculated. Because 51.6% of the participants were current or former smokers, logistic regression analysis was performed to control for smoking status. All statistical tests were two-sided.Results Compliance with screening decreased from 86.6% at baseline to 78.9% at the last screening. Overall positivity rates were 8.9% at baseline and 6.6%-7.1% at subsequent screenings; positivity rates increased modestly with smoking risk categories (P-trend < .001). The PPVs for all participants were 2.0% at baseline and 1.1%, 1.5%, and 2.4% at years 1, 2, and 3, respectively; PPVs in current smokers were 5.9% at baseline and 3.3%, 4.2%, and 5.6% at years 1, 2, and 3, respectively. A total of 564 lung cancers were diagnosed, of which 306 (54%) were screen-detected cancers and 87% were non-small cell lung cancers. Among non-small cell lung cancers, 59.6% of screen-detected cancers and 33.3% of interval cancers were early (I-II) stage.Conclusions The PLCO Cancer Screening Trial demonstrated the ability to recruit, retain, and screen a large population over multiple years at multiple centers. A higher proportion of screen-detected lung cancers were early stage, but a conclusion on the effectiveness of CXR screening must await final PLCO results, which are anticipated at the end of 2015.