Kinsey C Matthew, Hamlington Katharine L, O'Toole Jacqueline, Stapleton Renee, Bates Jason H T
Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States of America.
PLoS One. 2016 Nov 2;11(11):e0165471. doi: 10.1371/journal.pone.0165471. eCollection 2016.
Patients who survive an index lung cancer (ILC) after surgical resection continue to be at significant risk for a metachronous lung cancer (MLC). Indeed, this risk is much higher than the risk of developing an ILC in heavy smokers. There is currently little evidence upon which to base guidelines for screening at-risk patients for MLC, and the risk-reward tradeoffs for screening this patient population are unknown. The goal of this investigation was to estimate the maximum mortality benefit of CT screening for MLC. We developed a computational model to estimate the maximum rates of CT detection of MLC and surgical resection to be expected in a given population as a function of time after resection of an ILC. Applying the model to a hypothetical high-risk population suggests that screening for MLC within 5 years after resection of an ILC may identify only a very small number of treatable cancers. The risk of death from a potentially resectable MLC increases dramatically past this point, however, suggesting that screening after 5 years is imperative. The model also predicts a substantial detection gap for MLC that demonstrates the benefit to be gained as more sensitive screening methods are developed.
在接受手术切除后存活下来的原发性肺癌（ILC）患者，仍然面临着发生异时性肺癌（MLC）的重大风险。事实上，这种风险远高于重度吸烟者患原发性肺癌的风险。目前几乎没有证据可作为对有患MLC风险的患者进行筛查的指导方针依据，而且对这一患者群体进行筛查的风险与收益权衡尚不清楚。本研究的目的是估计CT筛查MLC的最大死亡率获益。我们开发了一个计算模型，以估计在给定人群中，作为原发性肺癌切除术后时间的函数，预计CT检测MLC和手术切除的最大发生率。将该模型应用于一个假设的高危人群表明，在原发性肺癌切除术后5年内筛查MLC可能只能发现极少数可治疗的癌症。然而，在此之后，潜在可切除的MLC导致的死亡风险会急剧增加，这表明5年后进行筛查势在必行。该模型还预测了MLC存在显著的检测差距，这表明随着开发出更敏感的筛查方法将能带来益处。
