Targeting of low-dose CT screening according to the risk of lung-cancer death.
Targeting of low-dose CT screening according to the risk of lung-cancer death.
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DOI：
10.1056/nejmoa1301851
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发表时间：
2013-07-18
期刊：
影响因子：
--
通讯作者：
Katki HA
中科院分区：
文献类型：
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作者：
Kovalchik SA;Tammemagi M;Berg CD;Caporaso NE;Riley TL;Korch M;Silvestri GA;Chaturvedi AK;Katki HA
在国家肺部筛查试验 (NLST) 中，低剂量计算机断层扫描 (CT) 筛查使年龄在 55 岁至 74 岁之间且吸烟年数至少为 30 包且戒烟时间不超过 15 年的参与者的肺癌死亡率降低了 20%。目前尚不清楚此类筛查的益处和潜在危害是否会根据肺癌风险而有所不同。我们根据 5 年肺癌死亡风险的五分位数（从最低风险组 [五分位数 1] 的 0.15% 到 0.55% 到超过最高风险组为 2.00% [五分位数 5]）。与放射线检查组相比，CT筛查组每年预防的肺癌死亡人数随风险五分位数而增加（第一五分位数为 0.2，第二五分位数为 3.5，第三五分位数为 5.1，第四五分位数为 11.0，第五五分位数为 12.0；趋势 P = 0.01）。在风险五分位中，每次筛查预防肺癌死亡的假阳性结果参与者人数呈显着下降趋势（五分位 1 为 1648 人，五分位 2 为 181 人，五分位 3 为 147 人，五分位 4 为 64 人，五分位 5 为 65 人）。肺癌死亡风险最高的 60% 参与者（五分位数 3 至 5）占筛查预防肺癌死亡的 88%，占假阳性结果参与者的 64%。 20% 的风险最低（五分位数 1）的参与者仅占预防肺癌死亡的 1%。低剂量 CT 筛查在高风险参与者中预防了最多的肺癌死亡人数，而在低风险参与者中预防了极少数死亡。这些发现为基于风险的吸烟者筛查提供了实证支持。 （由国家癌症研究所资助。）
In the National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) resulted in a 20% reduction in lung-cancer mortality among participants between the ages of 55 and 74 years with a minimum of 30 pack-years of smoking and no more than 15 years since quitting. It is not known whether the benefits and potential harms of such screening vary according to lung-cancer risk. We assessed the variation in efficacy, the number of false positive results, and the number of lung-cancer deaths prevented among 26,604 participants in the NLST who underwent low-dose CT screening, as compared with the 26,554 participants who underwent chest radiography, according to the quintile of 5-year risk of lung-cancer death (ranging from 0.15 to 0.55% in the lowest-risk group [quintile 1] to more than 2.00% in the highest-risk group [quintile 5]). The number of lung-cancer deaths per 10,000 person-years that were prevented in the CT-screening group, as compared with the radiography group, increased according to risk quintile (0.2 in quintile 1, 3.5 in quintile 2, 5.1 in quintile 3, 11.0 in quintile 4, and 12.0 in quintile 5; P = 0.01 for trend). Across risk quintiles, there were significant decreasing trends in the number of participants with false positive results per screening-prevented lung-cancer death (1648 in quintile 1, 181 in quintile 2, 147 in quintile 3, 64 in quintile 4, and 65 in quintile 5). The 60% of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88% of the screening-prevented lung-cancer deaths and for 64% of participants with false positive results. The 20% of participants at lowest risk (quintile 1) accounted for only 1% of prevented lung-cancer deaths. Screening with low-dose CT prevented the greatest number of deaths from lung cancer among participants who were at highest risk and prevented very few deaths among those at lowest risk. These findings provide empirical support for risk-based targeting of smokers for such screening. (Funded by the National Cancer Institute.)