McMahon Pamela M, Meza Rafael, Plevritis Sylvia K, Black William C, Tammemagi C Martin, Erdogan Ayca, ten Haaf Kevin, Hazelton William, Holford Theodore R, Jeon Jihyoun, Clarke Lauren, Kong Chung Yin, Choi Sung Eun, Munshi Vidit N, Han Summer S, van Rosmalen Joost, Pinsky Paul F, Moolgavkar Suresh, de Koning Harry J, Feuer Eric J
Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America.
PLoS One. 2014 Jun 30;9(6):e99978. doi: 10.1371/journal.pone.0099978. eCollection 2014.
The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking.
We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. 'Efficient' (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 'consensus efficient' (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient.
Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics.
国家肺癌筛查试验（NLST）表明，在年龄为55至74岁的现吸烟者和既往吸烟者中，有至少30包年的吸烟史且戒烟时间不超过15年，与每年进行3次胸部X光筛查相比，每年进行3次计算机断层扫描（CT）筛查可使肺癌特异性死亡率降低20%。我们比较了576种肺癌筛查方案的获益情况，这些方案在CT筛查的次数和频率、筛查年龄以及基于吸烟情况的资格标准方面存在差异。
我们使用了五个独立的微观模拟模型，这些模型的肺癌自然史参数先前已根据NLST进行校准，以模拟1950年出生的美国队列在所有576种方案下的生命历程。对于给定数量的CT筛查，与不进行筛查相比，“高效”（模型内）方案预防的肺癌死亡人数最多。在120种“共识高效”方案（在各模型中均被确定为高效）中，平均起始年龄为55岁，终止年龄为80或85岁，平均最低包年数为27，戒烟后的最长年限为20年。在共识高效方案中，11%至40%的队列接受了筛查，每10万人可避免153至846例肺癌死亡。在所有模型中，基于NLST年龄和吸烟资格标准的年度筛查效率不高；持续筛查至80或85岁更为高效。
五个模型的共识结果确定了一组高效的筛查方案，其中包括使用类似NLST资格标准但扩展至更高年龄的年度CT肺癌筛查。筛查指南还应考虑筛查的危害和个体患者特征。
