McMahon Pamela M, Kong Chung Yin, Weinstein Milton C, Tramontano Angela C, Cipriano Lauren E, Johnson Bruce E, Weeks Jane C, Gazelle G Scott
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Cancer. 2008 Dec 15;113(12):3440-9. doi: 10.1002/cncr.23962.
Simulation modeling can synthesize data from single-arm studies of lung cancer screening and tumor registries to investigate computed tomography (CT) screening. This study estimated changes in lung cancer outcomes through 2005, had chest CT screening been introduced in 1990.
Hypothetical individuals with smoking histories representative of 6 US cohorts (white males and females aged 50, 60, and 70 years in 1990) were simulated in the Lung Cancer Policy Model, a comprehensive patient-level simulation model of lung cancer development, screening, and treatment. A no screening scenario corresponded to observed outcomes. We simulated 3 screening scenarios in current or former smokers with > or =20 pack-years as follows: 1-time screen in 1990; and annual, and twice-annually screenings beginning in 1990 and ending in 2005. Main outcomes were days of life between 1990 and 2005 and life expectancy in 1990 (estimated by simulating life histories past 2005).
All screening scenarios yielded reductions (compared with no screening) in lung cancer-specific mortality by 2005, with larger reductions predicted for more frequent screening. Compared with no screening, annual screening of ever-smokers with at least 20 pack-years of cigarette exposure provided ever-smokers with an additional 11 to 33 days of life by 2005, or an additional 3-10 weeks of (undiscounted) life expectancy. In sensitivity analyses, the largest effects on gains from annual screening were due to reductions in screening adherence and increased smoking cessation.
The adoption of CT screening, had it been available in 1990, might have resulted in a modest gain in life expectancy.
模拟建模可以综合肺癌筛查单臂研究和肿瘤登记处的数据，以研究计算机断层扫描（CT）筛查。本研究估计了如果在1990年引入胸部CT筛查，到2005年肺癌结局的变化。
在肺癌政策模型中模拟了具有代表6个美国队列吸烟史的假设个体（1990年50、60和70岁的白人男性和女性），该模型是一个关于肺癌发展、筛查和治疗的全面患者水平模拟模型。无筛查情景对应于观察到的结局。我们在当前或既往吸烟≥20包年的人群中模拟了3种筛查情景，如下：1990年进行1次筛查；以及从1990年开始至2005年结束的每年1次和每年2次筛查。主要结局是1990年至2005年的生存天数以及1990年的预期寿命（通过模拟2005年以后的生命历程估计）。
到2005年，所有筛查情景均使肺癌特异性死亡率降低（与无筛查相比），更频繁的筛查预计降低幅度更大。与无筛查相比，对至少有20包年香烟暴露的既往吸烟者进行每年1次筛查，到2005年为既往吸烟者提供了额外11至33天的生命，或额外3 - 10周的（未贴现）预期寿命。在敏感性分析中，对每年1次筛查获益影响最大的是筛查依从性降低和戒烟增加。
如果1990年就有CT筛查，采用它可能会使预期寿命有适度提高。
