Lung Cancer Incidence and Mortality with Extended Follow-up in the National Lung Screening Trial
Lung Cancer Incidence and Mortality with Extended Follow-up in the National Lung Screening Trial
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DOI：
10.1016/j.jtho.2019.05.044
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发表时间：
2019-10-01
影响因子：
20.4
通讯作者：
Sicks, JoRean D.
中科院分区：
文献类型：
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作者：
Aberle, Denise R.;Black, William C.;Sicks, JoRean D.
简介：国家肺部筛查试验 (NLST) 将高危吸烟者和既往吸烟者随机分为三年一次，采用低剂量计算机断层扫描 (LDCT) 或胸部 X 线摄影 (CXR) 进行筛查，结果显示，经过中位 6.5 年的随访后，LDCT 组的肺癌死亡率显着降低。我们报告了 NLST 受试者的长期随访。方法：通过与州癌症登记处和国家死亡指数的联系对受试者进行跟踪。预防一名肺癌死亡所需筛查（NNS）的人数计算为各组死于肺癌的患者比例差异的倒数。总体计算肺癌死亡率比 (RR)，并根据稀释效应进行调整，后者仅包括距方案筛查结束足够近的相应诊断的死亡。结果：发病率的中位随访时间为 11.3 年，死亡率的中位随访时间为 12.3 年。总之，LDCT 组和 CXR 组分别诊断出 1701 例和 1681 例肺癌（RR = 1.01，95% 置信区间 [CI]：0.95-1.09）。观察到的肺癌死亡人数为 1147 例（LDCT）与 1236 例（CXR）（RR = 0.92，95% CI：0.85-1.00）。各组间死于肺癌的患者人数（每 1000 人）差异为 3.3，转化为 NNS 为 303，与 NNS 最初估计的 320 左右相似。稀释调整后的肺癌死亡率 RR 为 0.89（95% CI：0.80-0.997）。就总死亡率而言，有 5253 例（LDCT）和 5366 例（CXR）死亡，各组间差异（每 1000 例）为 4.2（95% CI：-2.6 至 10.9）。 结论：NLST 的长期随访显示 NNS 与原始分析相似。与 CXR 组相比，LDCT 组的肺癌发病率总体上没有增加。由爱思唯尔公司代表国际肺癌研究协会出版。
Introduction: The National Lung Screening Trial (NLST) randomized high-risk current and former smokers to three annual screens with either low-dose computed tomography (LDCT) or chest radiography (CXR) and demonstrated a significant reduction in lung cancer mortality in the LDCT arm after a median of 6.5 years' follow-up. We report on extended follow-up of NLST subjects.Methods: Subjects were followed by linkage to state cancer registries and the National Death Index. The number needed to screen (NNS) to prevent one lung cancer death was computed as the reciprocal of the difference in the proportion of patients dying of lung cancer across arms. Lung cancer mortality rate ratios (RRs) were computed overall and adjusted for dilution effect, with the latter including only deaths with a corresponding diagnosis close enough to the end of protocol screening.Results: The median follow-up times were 11.3 years for incidence and 12.3 years for mortality. In all, 1701 and 1681 lung cancers were diagnosed in the LDCT and CXR arms, respectively (RR = 1.01, 95% confidence interval [CI]: 0.95-1.09). The observed numbers of lung cancer deaths were 1147 (with LDCT) versus 1236 (with CXR) (RR = 0.92, 95% CI: 0.85-1.00). The difference in the number of patients dying of lung cancer (per 1000) across arms was 3.3, translating into an NNS of 303, which is similar to the original NNS estimate of around 320. The dilution-adjusted lung cancer mortality RR was 0.89 (95% CI: 0.80-0.997). With regard to overall mortality, there were 5253 (with LDCT) and 5366 (with CXR) deaths, for a difference across arms (per 1000) of 4.2 (95% CI: -2.6 to 10.9).Conclusion: Extended follow-up of the NLST showed an NNS similar to that of the original analysis. There was no overall increase in lung cancer incidence in the LDCT arm versus in the CXR arm. Published by Elsevier Inc. on behalf of International Association for the Study of Lung Cancer.