Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Thorax. 2017 Sep;72(9):819-824. doi: 10.1136/thoraxjnl-2016-209892. Epub 2017 Mar 30.
Debate about the optimal lung cancer screening strategy is ongoing. In this study, previous screening history of the Dutch-Belgian Lung Cancer Screening trial (NELSON) is investigated on if it predicts the screening outcome (test result and lung cancer risk) of the final screening round.
15 792 participants were randomised (1:1) of which 7900 randomised into a screening group. CT screening took place at baseline, and after 1, 2 and 2.5 years. Initially, three screening outcomes were possible: negative, indeterminate or positive scan result. Probability for screening outcome in the fourth round was calculated for subgroups of participants.
Based on results of the first three rounds, three subgroups were identified: (1) those with exclusively negative results (n=3856; 73.0%); (2) those with ≥1 indeterminate result, but never a positive result (n=1342; 25.5%); and (3) with ≥1 positive result (n=81; 1.5%). Group 1 had the highest probability for having a negative scan result in round 4 (97.2% vs 94.8% and 90.1%, respectively, p<0.001), and the lowest risk for detecting lung cancer in round 4 (0.6% vs 1.6%, p=0.001). 'Smoked pack-years' and 'screening history' significantly predicted the fourth round test result. The third round results implied that the risk for detecting lung cancer (after an interval of 2.5 years) was 0.6% for those with negative results compared with 3.7% of those with indeterminate results.
Previous CT lung cancer screening results provides an opportunity for further risk stratifications of those who undergo lung cancer screening.
Results, ISRCTN63545820.
关于最佳肺癌筛查策略的争论仍在继续。本研究旨在探讨荷兰-比利时肺癌筛查试验（NELSON）的既往筛查史是否能预测最终筛查轮次的筛查结果（检查结果和肺癌风险）。
共有 15792 名参与者被随机分配（1:1），其中 7900 名被随机分配至筛查组。CT 筛查在基线、1、2 和 2.5 年后进行。最初，可能出现三种筛查结果：阴性、不确定或阳性扫描结果。计算了第四轮筛查中各亚组的筛查结果概率。
基于前三轮结果，确定了三个亚组：（1）结果均为阴性者（n=3856；73.0%）；（2）有≥1 次不确定结果，但从未有阳性结果者（n=1342；25.5%）；（3）有≥1 次阳性结果者（n=81；1.5%）。第 1 组在第 4 轮出现阴性扫描结果的概率最高（97.2%对 94.8%和 90.1%，p<0.001），第 4 轮检测出肺癌的风险最低（0.6%对 1.6%，p=0.001）。“吸烟包年数”和“筛查史”显著预测了第 4 轮检查结果。第 3 轮结果表明，阴性结果者检测出肺癌的风险（间隔 2.5 年后）为 0.6%，不确定结果者为 3.7%。
既往 CT 肺癌筛查结果为接受肺癌筛查者提供了进一步进行风险分层的机会。
结果，ISRCTN63545820。
