Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Lung Cancer. 2013 Dec;82(3):426-30. doi: 10.1016/j.lungcan.2013.08.026. Epub 2013 Sep 8.
It is unclear how long low-dose computed tomographic (LDCT) screening should continue in populations at high risk of lung cancer. We assessed outcomes and the predictive ability of the COSMOS prediction model in volunteers screened for 10 years.
Smokers and former smokers (>20 pack-years), >50 years, were enrolled over one year (2000-2001), receiving annual LDCT for 10 years. The frequency of screening-detected lung cancers was compared with COSMOS and Bach risk model estimates.
Among 1035 recruited volunteers (71% men, mean age 58 years) compliance was 65% at study end. Seventy-one (6.95%) lung cancers were diagnosed, 12 at baseline. Disease stage was: IA in 48 (66.6%); IB in 6; IIA in 5; IIB in 2; IIIA in 5; IIIB in 1; IV in 5; and limited small cell cancer in 3. Five- and ten-year survival were 64% and 57%, respectively, 84% and 65% for stage I. Ten (12.1%) received surgery for a benign lesion. The number of lung cancers detected during the first two screening rounds was close to that predicted by the COSMOS model, while the Bach model accurately predicted frequency from the third year on.
Neither cancer frequency nor proportion at stage I decreased over 10 years, indicating that screening should not be discontinued. Most cancers were early stage, and overall survival was high. Only a limited number of invasive procedures for benign disease were performed. The Bach model - designed to predict symptomatic cancers - accurately predicted cancer frequency from the third year, suggesting that overdiagnosis is a minor problem in lung cancer screening. The COSMOS model - designed to estimate screening-detected lung cancers - accurately predicted cancer frequency at baseline and second screening round.
目前尚不清楚高危肺癌人群的低剂量计算机断层扫描（LDCT）筛查应持续多长时间。我们评估了志愿者接受 10 年筛查的结果和 COSMOS 预测模型的预测能力。
在一年期间（2000-2001 年），招募吸烟者和曾吸烟者（>20 包年），年龄>50 岁，每年接受 LDCT 检查 10 年。与 COSMOS 和 Bach 风险模型的估计值相比，比较筛查检测到的肺癌的频率。
在 1035 名招募的志愿者中（71%为男性，平均年龄为 58 岁），研究结束时的依从率为 65%。诊断出 71 例（6.95%）肺癌，其中 12 例为基线期。疾病分期为：IA 期 48 例（66.6%）；IB 期 6 例；IIA 期 5 例；IIB 期 2 例；IIIA 期 5 例；IIIB 期 1 例；IVA 期 5 例；局限小细胞癌 3 例。5 年和 10 年生存率分别为 64%和 57%，IA 期为 84%和 65%。10 例（12.1%）因良性病变接受手术治疗。前两轮筛查检测到的肺癌数量接近 COSMOS 模型预测的数量，而 Bach 模型则从第三年开始准确预测了癌症的频率。
10 年内，肺癌的检出率和 I 期比例均未下降，表明筛查不应停止。大多数癌症处于早期阶段，总体生存率较高。仅对少数良性疾病进行了有创性治疗。Bach 模型（旨在预测有症状的癌症）准确地预测了从第三年开始的癌症发病率，这表明肺癌筛查中的过度诊断是一个小问题。COSMOS 模型（旨在估计筛查检测到的肺癌）准确地预测了基线和第二轮筛查的癌症发病率。
