Bepler Gerold, Goodridge Carney Dawn, Djulbegovic Benjamin, Clark Robert A, Tockman Melvyn
Thoracic Oncology Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa 33612, USA.
Cancer Control. 2003 Jul-Aug;10(4):306-14. doi: 10.1177/107327480301000405.
Computed tomography (CT) screening of the chest has shown promise for early detection of lung cancer, but evidence for a reduction in lung cancer mortality by CT screening is not available.
We reviewed 208 articles to synthesize available evidence for efficacy of CT screening in detecting potentially curative stages of lung cancer and for evidence in reducing lung cancer mortality. Other outcomes of interest included detection rate of cancer and of suspicious lesions, histology and stage of cancer at detection, screening-related morbidity, and the identification of populations uniquely suited for CT screening. We identified eight papers that reported the outcomes for CT of the chest in lung cancer screening.
Since none of the studies utilized a control group, quantitative pooling was not done. In two studies, both CT and chest radiography (CXR) were used as screening tools in the same cohorts. A total of 19,107 subjects were screened using CT. The detected prevalence rate for lung cancer ranged from 0.40% to 13.6% and was a function of the subjects' age and smoking history. CT screening resulted in a 3-fold higher detection rate and a 5-fold increase in the rate of resectable cancers compared to CXR. Data on lung cancer and overall mortality and screening-related morbidity and mortality were incomplete. CT screening resulted in selective detection of adenocarcinomas with an approximately 2- to 3-fold oversampling of this histologic subtype. The positive predictive value of CT screening was highest for subjects in the 8th decade of life, and it was virtually nil for those in their 5th decade.
Evidence regarding lung cancer screening by CT shows that this technology detects earlier-stage and smaller lung cancers with greater frequency than other screening methods. To date, no trials have demonstrated that CT screening leads to a reduction in lung cancer mortality. Until mortality trials are completed, low-dose CT screening should be considered an investigative tool rather than the standard of care.
胸部计算机断层扫描（CT）筛查在肺癌早期检测方面显示出前景，但尚无证据表明CT筛查可降低肺癌死亡率。
我们查阅了208篇文章，以综合现有证据，证明CT筛查在检测肺癌潜在可治愈阶段的疗效以及降低肺癌死亡率的证据。其他感兴趣的结果包括癌症和可疑病变的检出率、检测时癌症的组织学和分期、筛查相关的发病率，以及确定特别适合CT筛查的人群。我们确定了八篇报告肺癌筛查中胸部CT结果的论文。
由于没有一项研究使用对照组，因此未进行定量汇总。在两项研究中，CT和胸部X线摄影（CXR）在同一队列中均用作筛查工具。共有19107名受试者接受了CT筛查。肺癌的检出患病率在0.40%至13.6%之间，是受试者年龄和吸烟史的函数。与CXR相比，CT筛查导致的检出率高出3倍，可切除癌症的发生率增加5倍。关于肺癌和总死亡率以及筛查相关发病率和死亡率的数据不完整。CT筛查导致腺癌的选择性检测，这种组织学亚型的采样率大约高出2至3倍。CT筛查的阳性预测值在80岁人群中最高，而在50岁人群中几乎为零。
关于CT肺癌筛查的证据表明，该技术比其他筛查方法更频繁地检测到早期和更小的肺癌。迄今为止，尚无试验表明CT筛查可降低肺癌死亡率。在死亡率试验完成之前，低剂量CT筛查应被视为一种研究工具，而非标准治疗方法。
