Performance of Risk Factor-Based Guidelines and Model-Based Chest CT Lung Cancer Screening in World Trade Center-Exposed Fire Department Rescue/Recovery Workers
Performance of Risk Factor-Based Guidelines and Model-Based Chest CT Lung Cancer Screening in World Trade Center-Exposed Fire Department Rescue/Recovery Workers
复制标题
DOI：
10.1016/j.chest.2020.11.028
复制
发表时间：
2021-05-05
期刊：
影响因子：
9.6
通讯作者：
Prezant, David J.
中科院分区：
文献类型：
--
作者：
Cleven, Krystal L.;Vaeth, Brandon;Prezant, David J.
背景：肺癌是美国癌症发病率和死亡率的主要原因。基于风险因素的指南和基于风险模型的策略被用来确定哪些患者可以从低剂量胸部CT(LDCT)筛查中受益。很少有研究比较同一队列中的指南或模型。我们评估了两种基于风险因素的指南(美国预防服务工作组2014建议[USPSTF-2014]和国家综合癌症网络第二组[NCCN-2])和两种基于风险模型的策略(前列腺癌、结直肠癌和卵巢癌筛查(PLCOm2012)和Bach模型)在相同职业队列中的肺癌筛查性能。研究问题：在高度暴露的职业队列中，哪种基于风险因素的指南或基于模型的策略在检测肺癌方面最准确？研究设计和方法：纽约市消防局(FDNY)救援/恢复人员暴露于9·112001年进行了基于吸烟史和年龄的低密度CT肺癌筛查。应用USPSTF-2014、NCCN-2、PLCOm2012模型和Bach模型进行回顾性研究，以确定每种方法诊断出的肺癌人数。结果：在研究人群中(N=3953)，930人接受了基线扫描，满足至少一个危险因素或基于模型的LDCT筛查策略；73%接受了年度随访扫描。在3953人中，63人被诊断为肺癌，其中50人是通过至少一种LDCT筛查策略发现的。NCCN-2指南最敏感(79.4%；50/63)。与NCCN-2相比，更严格的年龄和吸烟标准降低了其他指南/模型(USPSTF-2014[44%]、PLCOm2012[51%]和Bach[46%])的敏感性。漏掉的13例肺癌主要是由于吸烟较少和戒烟时间超过指南/模特资格标准所致。在所有四个指南/模型中，假阳性率相似。干预：在这个队列中，我们的发现支持通过将吸烟史从30美元一包年降低到20美元一包年和将年龄从55岁降低到50岁来扩大LDCT肺癌筛查的资格。还需要进行更多的研究，以确定其推广到其他职业/环境暴露队列的能力。
BACKGROUND: Lung cancer is a leading cause of cancer incidence and death in the United States. Risk factor-based guidelines and risk model-based strategies are used to identify patients who could benefit from low-dose chest CT (LDCT) screening. Few studies compare guidelines or models within the same cohort. We evaluate lung cancer screening performance of two risk factor-based guidelines (US Preventive Services Task Force 2014 recommendations [USPSTF-2014] and National Comprehensive Cancer Network Group 2 [NCCN-2]) and two risk model-based strategies, Prostate Lung Colorectal and Ovarian Cancer Screening (PLCOm2012) and the Bach model) in the same occupational cohort.RESEARCH QUESTION: Which risk factor-based guideline or model-based strategy is most accurate in detecting lung cancers in a highly exposed occupational cohort?STUDY DESIGN AND METHODS: Fire Department of City of New York (FDNY) rescue/recovery workers exposed to the September 11, 2001 attacks underwent LDCT lung cancer screening based on smoking history and age. The USPSTF-2014, NCCN-2, PLCOm2012 model, and Bach model were retrospectively applied to determine how many lung cancers were diagnosed using each approach.RESULTS: Among the study population (N = 3,953), 930 underwent a baseline scan that met at least one risk factor or model-based LDCT screening strategy; 73% received annual follow-up scans. Among the 3,953, 63 lung cancers were diagnosed, of which 50 were detected by at least one LDCT screening strategy. The NCCN-2 guideline was the most sensitive (79.4%; 50/63). When compared with NCCN-2, stricter age and smoking criteria reduced sensitivity of the other guidelines/models (USPSTF-2014 [44%], PLCOm2012 [51%], and Bach[46%]). The 13 missed lung cancers were mainly attributable to smoking less and quitting longer than guideline/model eligibility criteria. False-positive rates were similar across all four guidelines/models.INTERPRETATION: In this cohort, our findings support expanding eligibility for LDCT lung cancer screening by lowering smoking history from $30 to $20 pack-years and age from 55 years to 50 years old. Additional studies are needed to determine its generalizability to other occupational/environmental exposed cohorts.