Racial Differences in Outcomes within the National Lung Screening Trial
Racial Differences in Outcomes within the National Lung Screening Trial
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DOI：
10.1164/rccm.201502-0259oc
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发表时间：
2015-07-15
影响因子：
24.7
通讯作者：
Silvestri, Gerard A.
中科院分区：
文献类型：
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作者：
Tanner, Nichole T.;Gebregziabher, Mulugeta;Silvestri, Gerard A.
理由：患有肺癌 (LC) 的黑人患者死亡率较高，因为他们病情较晚期，并且不太可能对早期疾病进行根治性切除。国家肺部筛查试验 (NLST) 证明，通过低剂量计算机断层扫描 (LDCT) 筛查高危患者，可改善 LC 死亡率。 LDCT 筛查对黑人的益处尚不清楚。目标：按种族检查 NLST 的结果。方法：这是对在 33 个美国中心进行的随机试验 (NCT00047385) 的二次分析。测量和主要结果：测量了总体死亡率和肺癌特异性死亡率。 LDCT 筛查降低了所有种族群体的 LC 死亡率，但在黑人中更是如此（风险比 [HR]，0.61 vs. 0.86）。吸烟增加了 LC 死亡的可能性，按种族分层时，黑人吸烟者的死亡可能性是白人吸烟者的两倍（HR，4.10 vs. 2.25）。调整社会人口统计和行为特征后，黑人的全因死亡率高于白人（HR，1.35；95% 置信区间，1.22-1.49）；然而，接受 LDCT 筛查的黑人的全因死亡率有所下降。与白人相比，黑人更年轻，更有可能是当前吸烟者，有更多的合并症，接受正规教育的年数也更少（P < 0.05）。结论：用 LDCT 筛查的黑人降低了肺癌死亡率。然而，与 LC 生存率提高相关的人口统计学特征在黑人中并不常见。 NLST 中黑人的总体死亡率高于白人，但接受筛查的黑人的死亡率有所提高，这表明该亚组获得护理的机会可能有所改善。为了降低 LC 筛查的死亡率，需要调整传播工作以满足该社区的需求。
Rationale: Black individuals with lung cancer (LC) experience higher mortality because they present with more advanced disease and are less likely to undergo curative resection for early-stage disease. The National Lung Screening Trial (NLST) demonstrated improved LC mortality by screening high-risk patients with low-dose computed tomography (LDCT). The benefit of LDCT screening in black individuals is unknown.Objectives: Examine results of the NLST by race.Methods: This was a secondary analysis of a randomized trial (NCT00047385) performed in 33 U.S. centers.Measurements and Main Results: Overall and lung cancer-specific mortality were measured. Screening with LDCT reduced LC mortality in all racial groups but more so in black individuals (hazard ratio [HR], 0.61 vs. 0.86). Smoking increased the likelihood of death from LC, and when stratified by race black smokers were twice as likely to die as white smokers (HR, 4.10 vs. 2.25). Adjusting for sociodemographic and behavioral characteristics, black individuals experienced higher all-cause mortality than white individuals (HR, 1.35; 95% confidence interval, 1.22-1.49); however, black individuals screened with LDCT had a reduction in all-cause mortality. Black individuals were younger, were more likely to be current smokers, had more comorbidities, and had fewer years of formal education than white individuals (P < 0.05).Conclusions: Black individuals screened with LDCT had decreased mortality from lung cancer. However, the demographics associated with improved LC survival were less commonly found in black individuals. The overall mortality in the NLST was higher for black individuals than white individuals, but improved in black individuals screened, suggesting that this subgroup may have had improved access to care. To realize the reductions in mortality from LC screening, dissemination efforts need to be tailored to meet the needs of this community.