Manser R L, Irving L B, Byrnes G, Abramson M J, Stone C A, Campbell D A
Clinical Epidemiology and Health Service Evaluation Unit, Ground Floor, Charles Connibere Building, Royal Melbourne Hospital, Grattan Street, Parkville 3050, Victoria, Australia.
Thorax. 2003 Sep;58(9):784-9. doi: 10.1136/thorax.58.9.784.
Lung cancer is a substantial public health problem in western countries. Previous studies have examined different screening strategies for lung cancer but there have been no published systematic reviews.
A systematic review of controlled trials was conducted to determine whether screening for lung cancer using regular sputum examinations or chest radiography or computed tomography (CT) reduces lung cancer mortality. The primary outcome was lung cancer mortality; secondary outcomes were lung cancer survival and all cause mortality.
One non-randomised controlled trial and six randomised controlled trials with a total of 245 610 subjects were included in the review. In all studies the control group received some type of screening. More frequent screening with chest radiography was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23). A non-statistically significant trend to reduced mortality from lung cancer was observed when screening with chest radiography and sputum cytological examination was compared with chest radiography alone (RR 0.88, 95% CI 0.74 to 1.03). Several of the included studies had potential methodological weaknesses. Controlled studies of spiral CT scanning have not been reported.
The current evidence does not support screening for lung cancer with chest radiography or sputum cytological examination. Frequent chest radiography might be harmful. Further methodologically rigorous trials are required before any new screening methods are introduced into clinical practice.
肺癌在西方国家是一个重大的公共卫生问题。以往的研究探讨了不同的肺癌筛查策略，但尚无已发表的系统评价。
进行了一项对照试验的系统评价，以确定使用定期痰检、胸部X线摄影或计算机断层扫描（CT）筛查肺癌是否能降低肺癌死亡率。主要结局是肺癌死亡率；次要结局是肺癌生存率和全因死亡率。
该评价纳入了1项非随机对照试验和6项随机对照试验，共245610名受试者。在所有研究中，对照组都接受了某种类型的筛查。与筛查频率较低相比，更频繁的胸部X线摄影筛查与肺癌死亡率相对增加11%相关（风险比1.11，95%可信区间1.00至1.23）。当将胸部X线摄影和痰细胞学检查与单纯胸部X线摄影进行比较时，观察到肺癌死亡率有降低的趋势，但无统计学意义（风险比0.88，95%可信区间0.74至1.03）。纳入的几项研究存在潜在的方法学缺陷。尚未报道螺旋CT扫描的对照研究。
目前的证据不支持用胸部X线摄影或痰细胞学检查筛查肺癌。频繁的胸部X线摄影可能有害。在将任何新的筛查方法引入临床实践之前，需要进行进一步方法学严谨的试验。
