Benefits and harms of CT screening for lung cancer: a systematic review.
Benefits and harms of CT screening for lung cancer: a systematic review.
复制标题
DOI：
10.1001/jama.2012.5521
复制
发表时间：
2012-06-13
影响因子：
120.7
通讯作者：
Detterbeck, Frank C.
中科院分区：
文献类型：
--
作者：
Bach, Peter B.;Mirkin, Joshua N.;Oliver, Thomas K.;Azzoli, Christopher G.;Berry, Donald A.;Brawley, Otis W.;Byers, Tim;Colditz, Graham A.;Gould, Michael K.;Jett, James R.;Sabichi, Anita L.;Smith-Bindman, Rebecca;Wood, Douglas E.;Qaseem, Amir;Detterbeck, Frank C.
肺癌是癌症死亡的主要原因。大多数患者被诊断为晚期疾病，导致五年生存率非常低。筛查可以降低肺癌死亡的风险。一项多协会合作倡议（包括美国癌症协会、美国胸科医师学会、美国临床肿瘤学会和国家综合癌症网络）开展了一项关于使用低剂量计算机断层扫描（LDCT）进行肺癌筛查的益处和危害的证据的系统综述，以便为制定循证临床指南奠定基础。MEDLINE （OVID: 1996年至2012年4月），EMBASE （OVID: 1996年至2012年4月）和Cochrane图书馆（2012年4月）。在591篇文献中，8项随机对照试验和13项LDCT筛查队列研究符合纳入标准。主要结局是肺癌死亡率和全因死亡率，次要结局包括结节检测、侵入性手术、随访检查和戒烟。使用预先定义的标准对个别研究和整体证据进行了批判性评估。审稿人提取的数据的差异是通过共识来裁决的。三项随机研究提供了LDCT筛查对肺癌死亡率影响的证据，其中国家肺部筛查试验提供的信息最多，表明在53,454名受试者中，筛查导致肺癌死亡人数显著减少（356人对443人死亡）；LDCT组和对照组的肺癌特异性死亡率分别为每10万人年247人对309人；相对危险度[RR] = 0.80, 95%可信区间[CI] 0.73-0.93；绝对风险降低[ARR] = 0.33%， P=0.004)。另外两项较小的研究没有显示出这样的好处。就LDCT筛查的潜在危害而言，在所有试验和队列中，每轮筛查中约有20%的个体具有阳性结果，需要一定程度的随访，而约1%的个体患有肺癌。在这一发现以及随访调查、活检的频率和良性病变的外科手术的百分比方面存在明显的异质性。良性病变的主要并发症是罕见的。LDCT筛查可能对肺癌高危人群有益，但存在潜在危害和结果的普遍性的不确定性。
Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low five-year survival rate. Screening may reduce the risk of death from lung cancer. A multi-society collaborative initiative (involving the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network) was undertaken to conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low dose computed tomography (LDCT), in order to create the foundation for development of an evidence-based clinical guideline. MEDLINE (OVID: 1996 to April 2012), EMBASE (OVID: 1996 to April 2012), and the Cochrane Library (April 2012). Of 591 citations identified and reviewed, eight randomized controlled trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation. Critical appraisal using pre-defined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus. Three randomized studies provided evidence on the impact of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53,454 enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 247 vs 309 events per 100,000 person-years for LDCT and control groups, respectively; Relative Risk [RR] = 0.80, 95% Confidence Interval [CI] 0.73–0.93; Absolute Risk Reduction [ARR] = 0.33%, P=0.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, about 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and the percent of surgical procedures performed in those with benign lesions. Major complications in those with benign conditions were rare. LDCT screening may benefit individuals at an elevated risk for lung cancer, but uncertainty exists about potential harms and the generalizability of results.
登录
查看更多内容
影响因子：
10
作者：
Ashraf, H.;Tonnesen, P.;Dossing, M.
通讯作者：
Dossing, M.
影响因子：
5.9
作者：
Diederich, S;Thomas, M;Wormanns, D
通讯作者：
Wormanns, D
影响因子：
10
作者：
BRETT, GZ
通讯作者：
BRETT, GZ
影响因子：
10.3
作者：
Aberle, Denise R.;Adams, Amanda M.;Pinsky, Paul F.
通讯作者：
Pinsky, Paul F.
DOI：
10.1097/00043764-198608000-00038
发表时间：
1986-08-01
影响因子：
3.2
作者：
FONTANA, RS;SANDERSON, DR;MUHM, JR
通讯作者：
MUHM, JR