Departments of Pulmonary/Critical Care, and daggerHematology/Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, USA.
J Thorac Oncol. 2010 Aug;5(8):1233-9. doi: 10.1097/JTO.0b013e3181e0b977.
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.
肺癌是所有癌症中导致死亡的主要原因。据估计，目前全球有 15 岁以上的 29%的人口吸烟。由于高危人群的存在、疾病在早期阶段相对无症状的性质以及早期发现时相对较好的预后，使得肺癌筛查成为一个有吸引力的提议。我们对迄今为止已发表的随机对照试验的基线结果进行了系统评价和荟萃分析，这些试验包括了超过 14000 名患者。分析用于确定使用低剂量计算机断层扫描（LDCT）筛查肺癌的数据是支持还是反对。
系统评价和荟萃分析的随机效应荟萃回归模型。
我们对当前文献进行了系统评价和荟萃分析，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结果。使用 Medline 进行了搜索策略，根据预设标准选择研究，并应用排除标准，收集和分析数据以确定统计学意义。
使用 LDCT 筛查肺癌导致Ⅰ期肺癌的数量显著增加（优势比 3.9，95%置信区间[CI] 2.0-7.4），非小细胞肺癌总数增加（优势比 5.5，95%CI 3.1-9.6），肺癌总数增加（优势比 4.1，95%CI 2.4-7.1）。LDCT 筛查还导致更多的假阳性结节的检测（优势比 3.1，95%CI 2.6-3.7）和更多的良性病变需要开胸手术（发生率为 3.7/1000，95%CI 3.5-3.8）。在使用 LDCT 筛查肺癌的 1000 人中，发现了 9 例Ⅰ期非小细胞肺癌和 235 例假阳性结节，有 4 例良性病变需要开胸手术。
六项随机对照试验的基线数据没有提供有力的证据支持或反对使用 LDCT 筛查肺癌。我们等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。
