N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873. Epub 2011 Jun 29.
The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer.
From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009.
The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02).
Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).
肺癌具有侵袭性和异质性，这使得通过筛查来降低死亡率的努力受挫。低剂量螺旋 CT 的出现改变了肺癌筛查的格局，研究表明低剂量 CT 可在早期检测到许多肿瘤。国家肺癌筛查试验（NLST）旨在确定低剂量 CT 筛查是否可以降低肺癌死亡率。
2002 年 8 月至 2004 年 4 月，我们在 33 个美国医疗中心招募了 53454 名肺癌高危人群。参与者被随机分配接受三次年度筛查，分别使用低剂量 CT（26722 名参与者）或单视野后前位胸部 X 线摄影（26732 名参与者）。数据收集了截至 2009 年 12 月 31 日发生的肺癌病例和肺癌死亡情况。
筛查的依从率超过 90%。低剂量 CT 的阳性筛查率为 24.2%，而 X 线摄影的阳性筛查率为 6.9%，在所有三轮筛查中均如此。低剂量 CT 组 96.4%的阳性筛查结果和 X 线摄影组 94.5%的阳性筛查结果为假阳性。低剂量 CT 组的肺癌发病率为每 100000 人年 645 例（1060 例癌症），而 X 线摄影组为每 100000 人年 572 例（941 例癌症）（发病率比，1.13；95%置信区间[CI]，1.03 至 1.23）。低剂量 CT 组每 100000 人年有 247 人死于肺癌，X 线摄影组每 100000 人年有 309 人死于肺癌，低剂量 CT 筛查使肺癌死亡率相对降低 20.0%（95%CI，6.8%至 26.7%；P=0.004）。与 X 线摄影组相比，低剂量 CT 组的任何原因死亡率降低了 6.7%（95%CI，1.2%至 13.6%；P=0.02）。
使用低剂量 CT 筛查可降低肺癌死亡率。（由美国国家癌症研究所资助；国家肺癌筛查试验 ClinicalTrials.gov 编号，NCT00047385。）
