Yi Chin A, Lee Kyung Soo, Shin Myung-Hee, Cho Yun Yung, Choi Yoon-Ho, Kwon O Jung, Shin Kyung Eun
Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea.
Eur Radiol. 2015 Aug;25(8):2335-45. doi: 10.1007/s00330-015-3620-8. Epub 2015 Feb 14.
To evaluate the performance of low-dose CT (LDCT) screening for lung cancer (LCA) detection in an Asian population with diverse risks for LCA.
LCA screening was performed in 12,427 symptomless Asian subjects using either LDCT (5,771) or chest radiography (CXR) (6,656) in a non-trial setting. Subjects were divided into high-risk and non-high-risk groups. Data were collected on the number of patients with screening-detected LCAs and their survival in order to compare outcomes between LDCT and CXR screening with the stratification of risks considering age, sex and smoking status.
In the non-high-risk group, a significant difference was observed for the detection of lung cancer (adjusted OR, 5.07; 95 % CI, 2.72-9.45) and survival (adjusted HR of LCA survival between LDCT vs. CXR group, 0.08; 95 % CI, 0.01-0.62). No difference in detection or survival of LCA was noticed in the high-risk group. LCAs in the non-high-risk group were predominantly adenocarcinomas (96 %), and more likely to be part-solid or non-solid compared with those in the high-risk group (p = 0.023).
In the non-high-risk group, LDCT helps detect more LCAs and offers better survival than CXR screening, due to better detection of part solid or non-solid lung adenocarcinomas.
• In an Asian non-high-risk group, LDCT helps detect more early-staged LCAs. • CT-detected lung cancers in non-high-risk subjects demonstrate better survival than CXR-detected cancers. • CT-detected lung cancers in non-high-risk subjects are predominantly part-solid or non-solid adenocarcinomas. • Mortality benefit of LDCT screening in non-high-risk subjects needs to be investigated.
评估低剂量CT（LDCT）筛查在具有不同肺癌风险的亚洲人群中检测肺癌（LCA）的性能。
在非试验环境中，对12427名无症状亚洲受试者进行LCA筛查，其中5771人使用LDCT，6656人使用胸部X线摄影（CXR）。受试者分为高危组和非高危组。收集筛查发现的LCA患者数量及其生存数据，以便在考虑年龄、性别和吸烟状况进行风险分层的情况下，比较LDCT和CXR筛查的结果。
在非高危组中，肺癌检测（校正OR，5.07；95%CI，2.72 - 9.45）和生存（LDCT组与CXR组之间LCA生存的校正HR，0.08；95%CI，0.01 - 0.62）存在显著差异。高危组在LCA检测或生存方面未发现差异。非高危组的LCA主要为腺癌（96%），与高危组相比，更可能为部分实性或非实性（p = 0.023）。
在非高危组中，由于能更好地检测部分实性或非实性肺腺癌，LDCT比CXR筛查能帮助检测出更多的LCA并提供更好的生存情况。
• 在亚洲非高危组中，LDCT有助于检测出更多早期LCA。• 非高危受试者中CT检测出的肺癌比CXR检测出的癌症生存情况更好。• 非高危受试者中CT检测出的肺癌主要为部分实性或非实性腺癌。• 非高危受试者中LDCT筛查的死亡率获益需要进一步研究。
