Studts Jamie L, Ghate Sameer R, Gill Jaime L, Studts Christina R, Barnes Christopher N, LaJoie A Scott, Andrykowski Michael A, LaRocca Renato V
Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, KY, USA.
Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1825-8. doi: 10.1158/1055-9965.EPI-06-0393.
Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on self-reported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared self-reported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the "gold standard," the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (kappa = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (kappa = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results.
肺癌仍然是一种具有严重发病率和死亡率的毁灭性疾病。最近的研究表明，螺旋计算机断层扫描进行肺癌筛查可能会降低肺癌死亡率。肺癌筛查研究还表明，大量参与者在筛查后戒烟。然而，大多数研究仅依赖自我报告的吸烟行为，而这在肺癌筛查参与者中可能不太准确。为了评估肺癌筛查试验参与者自我报告吸烟状况的有效性，本研究将自我报告的吸烟状况与尿可替宁水平进行了比较。样本包括连续55名参与一项随机临床试验的参与者，该试验比较了年度螺旋计算机断层扫描和胸部X光用于肺癌筛查的效果。参与者的平均年龄为59岁，主要是白种人（96%）和男性（55%）。在参与者得知生化验证研究的目的之前和之后，评估其自我报告的吸烟状况。以尿可替宁作为“金标准”，自我报告吸烟状况的敏感性和特异性分别为91%和95%（kappa = 0.85，P < 0.001，95%置信区间 = 0.71 - 0.99）。总错误分类率为7%。然而，四名错误分类的参与者中有三名报告同时使用尼古丁替代策略。从分析中排除这些病例后，敏感性为100%，特异性为95%（kappa = 0.96，P < 0.001，95%置信区间 = 0.88 - 1.00）。总之，肺癌筛查试验参与者自我报告的吸烟状况与尿可替宁检测结果高度一致。
