Miller Daniel L, Mayfield William R, Luu Theresa D, Helms Gerald A, Muster Alan R, Beckler Vickie J, Cann Aaron
Multidisciplinary Thoracic Oncology Program, WellStar Health System/Mayo Clinic Care Network, Marietta, Georgia.
Multidisciplinary Thoracic Oncology Program, WellStar Health System/Mayo Clinic Care Network, Marietta, Georgia.
Ann Thorac Surg. 2016 May;101(5):1864-9. doi: 10.1016/j.athoracsur.2015.11.001. Epub 2016 Feb 12.
Lung cancer is the most common cause of cancer deaths in the United States. Overall survival is less than 20%, with the majority of patients presenting with advanced disease. The National Lung Screening Trial, performed mainly in academic medical centers, showed that cancer mortality can be reduced with computed tomography (CT) screening compared with chest radiography in high-risk patients. To determine whether this survival advantage can be duplicated in a community-based multidisciplinary thoracic oncology program, we initiated a CT scan screening program for lung cancer within an established health care system.
In 2008, we launched a lung cancer CT screening program within the WellStar Health System (WHS) consisting of five hospitals, three health parks, 140 outpatient medical offices, and 12 imaging centers that provide care in a five-county area of approximately 1.4 million people in Metro-Atlanta. Screening criteria incorporated were the International Early Lung Cancer Action Program (2008 to 2010) and National Comprehensive Cancer Network guidelines (2011 to 2013) for moderate- and high-risk patients.
A total of 1,267 persons underwent CT lung cancer screening in WHS from 2008 through 2013; 53% were men, 87% were 50 years of age or older, and 83% were current or former smokers. Noncalcified indeterminate pulmonary nodules were found in 518 patients (41%). Thirty-six patients (2.8%) underwent a diagnostic procedure for positive findings on their CT scan; 30 proved to have cancer, 28 (2.2%) primary lung cancer and 2 metastatic cancer, and 6 had benign disease. Fourteen patients (50%) had their lung cancer discovered on their initial CT scan, 11 on subsequent scans associated with indeterminate pulmonary nodules growth and 3 patients who had a new indeterminate pulmonary nodules. Only 15 (54%) of these 28 patients would have qualified as a National Lung Screening Trial high-risk patient; 75% had stage I or II disease. Overall 5-year survival was 64% and 5-year cancer specific survival was 71% in the screened patients, whereas nonscreened lung cancer patients during that time in WHS had an overall survival of only 19% (p < 0.001).
A community-based multidisciplinary lung cancer screening program can improve survival of patients with lung cancer outside of a large multicenter study. This survival advantage was caused by a significant stage shift to earlier disease. Lung cancer CT screening may also benefit patients not meeting the National Lung Screening Trial criteria who are at moderate or high risk for lung cancer.
肺癌是美国癌症死亡的最常见原因。总体生存率低于20%，大多数患者就诊时已处于疾病晚期。主要在学术医疗中心开展的国家肺癌筛查试验表明，与胸部X线摄影相比，计算机断层扫描（CT）筛查可降低高危患者的癌症死亡率。为了确定这种生存优势能否在基于社区的多学科胸科肿瘤项目中重现，我们在一个成熟的医疗保健系统内启动了一项肺癌CT筛查项目。
2008年，我们在韦尔斯塔尔健康系统（WHS）内启动了一项肺癌CT筛查项目，该系统包括五家医院、三个健康园区、140个门诊医疗办公室和12个影像中心，在大亚特兰大地区一个约140万人的五县区域提供医疗服务。纳入的筛查标准是国际早期肺癌行动计划（2008年至2010年）以及国家综合癌症网络针对中高危患者的指南（2011年至2013年）。
2008年至2013年期间，共有1267人在WHS接受了肺癌CT筛查；53%为男性，87%年龄在50岁及以上，83%为现吸烟者或既往吸烟者。518例患者（41%）发现有非钙化的不确定肺结节。36例患者（2.8%）因CT扫描阳性结果接受了诊断性检查；30例被证实患有癌症，28例（2.2%）为原发性肺癌，2例为转移性癌症，6例患有良性疾病。14例患者（50%）在初次CT扫描时发现肺癌，11例在随后与不确定肺结节生长相关的扫描中发现，3例患者有新的不确定肺结节。这28例患者中只有15例（54%）符合国家肺癌筛查试验高危患者标准；75%为I期或II期疾病。筛查患者的总体5年生存率为64%，5年癌症特异性生存率为71%，而在此期间WHS未筛查的肺癌患者总体生存率仅为19%（p<0.001）。
基于社区的多学科肺癌筛查项目可以提高大型多中心研究之外的肺癌患者的生存率。这种生存优势是由于疾病分期显著提前至早期所致。肺癌CT筛查可能也使不符合国家肺癌筛查试验标准但有中度或高度肺癌风险的患者受益。
