Reduced lung-cancer mortality with low-dose computed tomographic screening.
Reduced lung-cancer mortality with low-dose computed tomographic screening.
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通过低剂量计算的断层筛查降低了肺癌死亡率。
DOI：
10.1056/nejmoa1102873
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发表时间：
2011-08-04
期刊：
影响因子：
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通讯作者：
Sicks JD
中科院分区：
文献类型：
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作者：
National Lung Screening Trial Research Team;Aberle DR;Adams AM;Berg CD;Black WC;Clapp JD;Fagerstrom RM;Gareen IF;Gatsonis C;Marcus PM;Sicks JD
肺癌的侵袭性和异质性阻碍了通过筛查降低这种癌症死亡率的努力。低剂量螺旋计算机断层扫描(CT)的出现改变了肺癌筛查的格局，研究表明，低剂量CT在早期阶段就能检测到许多肿瘤。进行了全国肺部筛查试验(NLST)，以确定低剂量CT筛查是否可以降低肺癌死亡率。从2002年8月到2004年4月，我们在33个美国医疗中心招募了53,454名肺癌高危人群。参与者被随机分配接受三次年度筛查，要么接受低剂量CT(26722名参与者)，要么接受单视后前胸透(26732名)。收集了截至2009年12月31日的肺癌病例和肺癌死亡病例的数据。筛查依从率达90%以上。三轮低剂量CT筛查阳性率为24.2%，X线检查阳性率为6.9%。低剂量CT组96.4%的筛查结果为假阳性，X线组94.5%为假阳性。低剂量CT组的肺癌发病率为每10万人年645例(1060例癌症)，而放射组为每10万人年572例(941例癌)(比率比1.13；95%可信区间1.03至1.23)。低剂量CT组肺癌死亡率为247例/10万人年，放射组为309例/10万人年，低剂量CT筛查肺癌死亡率相对降低20.0%(95%可信区间为6.8%~26.7%；P=0.004)。与放射组相比，低剂量CT组的各种死因死亡率降低了6.7%(95%可信区间1.2~13.6；P=0.02)。使用低剂量CT进行筛查可降低肺癌死亡率。(由国家癌症研究所资助；国家肺筛查试验诊所Trials.gov编号，NCT00047385。)
The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P = 0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P = 0.02). Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.)