Mean sojourn time and effectiveness of mortality reduction for lung cancer screening with computed tomography
Mean sojourn time and effectiveness of mortality reduction for lung cancer screening with computed tomography
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DOI：
10.1002/ijc.23413
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发表时间：
2008-06-01
影响因子：
6.4
通讯作者：
Chen, Tony Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Chien, Chun-Ru;Chen, Tony Hsiu-Hsi
本研究旨在估计通过计算机断层扫描 (CT) 或胸部 X 射线 (CXR) 检测到的无症状肺癌 (ALC) 的平均逗留时间 (MST) 和敏感性。使用马尔可夫模型预测通过两种检测方式和筛查间隔将早期诊断转化为死亡率降低。在系统文献回顾的基础上，检索了6项前瞻性CT筛查研究的数据。使用贝叶斯方法估计与三态马尔可夫模型描述的肺癌自然史相关的 MST。为了预测筛查导致的死亡率降低，该模型进一步扩展到 5 个健康状态，以纳入预后部分。该分析是在 10 年的随访时间内进行的，模仿了荷兰-比利时随机肺癌筛查试验 (NELSON)。 CT 筛查肺癌的敏感性较高（中位值：97%），在检测 ALC 方面可能比 CXR 提前一年。通过模拟类似于 NELSON 研究的场景，CT 筛查可以使人均预期寿命额外延长 0.019 年，死亡率降低 15%（相对风险 (1111)：0.85，95% 置信区间 [95%CI：(0.58-1.01)]。大约 23% [RR：0.77，95%CI： (0.43-0.98)]死亡率将通过每年实现降低 CT 筛查计划。死亡率结果与较高的敏感性和较短的 MST 估计相结合，给出了流行和事件（第二次）筛查的数据，可能提供初步证据，表明可能需要每年进行 CT 筛查，以便在随机对照研究结果公布之前有效降低死亡率。 (c) 2008 年 Wiley-Liss, Inc.
This study aimed to estimate the mean sojourn time (MST) and sensitivity of asymptomatic lung cancer (ALC) detected by computed tomography (CT) or chest X-ray (CXR). Translation of early diagnosis into mortality reduction by 2 detection modalities and inter-screening interval was projected using a Markov model. On the basis of systematic literature review, data from 6 prospective CT screening studies were retrieved. The MST in association with the natural history of lung cancer depicted by a 3-state Markov model was estimated with a Bayesian approach. To project mortality reduction attributed to screening, the model was further extended to,5 health states for the inclusion of prognostic part. The analysis was run with a 10-year time horizon of follow-up, mimicking the Dutch-Belgian randomized lung cancer screening trial (NELSON). Screening for lung cancer with CT had high sensitivity (median: 97%) and may advance I year earlier than CXR in detecting ALC. By simulating the scenario similar to NELSON study, CT screen may gain an extra of 0.019 year of life expectancy per person, yields 15% mortality reduction (relative risk (1111): 0.85, 95% confidence interval [95%Cl: (0.58-1.01)]. Approximate 23% [RR: 0.77, 95%CI: (0.43-0.98)] mortality reduction would be achieved by annual CT screening program. The mortality findings in conjunction with higher sensitivity and shorter MST estimate given data on prevalent and incident (2nd) screen may provide a tentative evidence, suggesting that annual CT screening may be required in order to be effective in reducing mortality before the results of randomized controlled studies available. (c) 2008 Wiley-Liss, Inc.