Screening for lung cancer with low-dose computed tomography: a systematic review and meta-analysis of the baseline findings of randomized controlled trials.
Screening for lung cancer with low-dose computed tomography: a systematic review and meta-analysis of the baseline findings of randomized controlled trials.
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DOI：
10.1097/jto.0b013e3181e0b977
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发表时间：
2010-08
期刊：
影响因子：
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通讯作者：
Goodwin JS
中科院分区：
文献类型：
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作者：
Gopal M;Abdullah SE;Grady JJ;Goodwin JS
肺癌是所有癌症中最主要的死亡原因。据估计，全球15岁以上人口中有29%目前吸烟。高风险人群的存在、疾病在早期阶段相对无症状的性质以及早期发现时相对良好的预后使得肺癌筛查成为一个有吸引力的主张。我们对迄今为止发表的随机对照试验的基线结果进行了系统回顾和荟萃分析，其中包括14，000多名患者。分析用于确定数据是否支持或反对使用低剂量计算机断层扫描（LDCT）筛查肺癌。荟萃分析与系统评价的随机效应Meta回归模型。我们对现有文献进行了系统回顾和荟萃分析，以确定在高危人群中使用计算机断层扫描筛查肺癌是否能改善预后。采用Medline检索策略，根据预设标准和排除标准的应用选择研究，收集数据并分析统计学意义。使用LDCT筛查肺癌导致I期肺癌数量显著增加（比值比3.9，95%置信区间[CI] 2.0 - 7.4），非小细胞肺癌总数显著增加（比值比5.5，95% CI 3.1-9.6），肺癌总数显著增加（比值比4.1，95% CI 2.4 - 7.1）。使用LDCT筛查还导致假阳性结节检出率增加（比值比3.1，95% CI 2.6 - 3.7），以及更多不必要的良性病变开胸术（事件率3.7/1000，95% CI 3.5-3.8）。每1000例肺癌LDCT筛查患者中，检出9例I期非小细胞肺癌和235例假阳性结节，4例良性病变行开胸手术。6项随机对照试验的基线数据没有提供支持或反对使用LDCT筛查肺癌的令人信服的数据。我们期待这些随机对照试验的最终结果，以提高我们对LDCT在肺癌筛查中的有效性及其对死亡率的影响的理解。
Lung cancer is the leading cause of death among all cancers. An estimated 29% of the global population older than 15 years currently smokes tobacco. The presence of a high risk population, relatively asymptomatic nature of the disease in the early phase, and relatively good prognosis when discovered early makes screening for lung cancer an attractive proposition. We performed a systematic review and a meta-analysis of the baseline results of randomized controlled trials so far published, which included more than 14,000 patients. Analysis was used to determine whether data was for or against the screening of lung cancers using low-dose computed tomography (LDCT). Random effect meta regression model of meta-analysis and systematic review. We performed a systematic review and a meta-analysis of the current literature to determine whether screening for lung cancer in a high-risk population with computed tomography improves outcomes. A search strategy using Medline was employed, studies selected based on preset criteria and application of exclusion criteria, and data collected and analyzed for statistical significance. Screening for lung cancer using LDCT resulted in a significantly higher number of stage I lung cancers (odds ratio 3.9, 95% confidence interval [CI] 2.0 –7.4), higher number of total non-small cell lung cancers (odds ratio 5.5, 95% CI 3.1–9.6), and higher total lung cancers (odds ratio 4.1, 95% CI 2.4 –7.1). Screening using LDCT also resulted in increased detection of false-positive nodules (odds ratio 3.1, 95% CI 2.6 –3.7) and more unnecessary thoracotomies for benign lesions (event rate 3.7 per 1000, 95% CI 3.5–3.8). For every 1000 individuals screened with LDCT for lung cancer, 9 stage I non-small cell lung cancer and 235 false-positive nodules were detected, and 4 thoracotomies for benign lesions were performed. The baseline data from six randomized controlled trials offer no compelling data in favor or against the use of LDCT screening for lung cancer. We await the final results of these randomized controlled trials to improve our understanding of the effectiveness of LDCT in the screening for lung cancer and its effect on mortality.