Department of Radiology- Cardiopulmonary section, University of Alabama in Birmingham School of Medicine, 619 19th St S JTN 363, Birmingham, AL, 35233, USA.
Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
Eur Radiol. 2017 Dec;27(12):5113-5118. doi: 10.1007/s00330-017-4886-9. Epub 2017 Jun 14.
The National Lung Screening Trial (NLST) demonstrated a reduction in lung cancer and all-cause mortality with low-dose CT (LDCT) screening. The aim of our study was to examine the time to diagnosis (TTD) of lung cancer in the LDCT arm of the NLST and assess its relationship with cancer characteristics and survival.
The subjects (N = 462) with a positive baseline screen and subsequent lung cancer diagnosis within 3 years were evaluated by data and image review to confirm the baseline abnormality. The cases were analysed for the relationship between TTD and imaging features, cancer type, stage and survival for 7 years from baseline screen.
Cancer was judged to be present at baseline in 397/462 cases. The factors that showed significant association (p value trend less than 0.05) with longer TTD included smaller nodule size, pure ground glass nodules (GGNs), smooth/lobulated margins, stages I/II, adenocarcinoma, and decreasing lung cancer mortality. The logistic regression model for lung cancer death showed significant inverse relationships with size less than 20 mm (OR = 0.32), pure GGNs (OR = 0.24), adenocarcinoma (OR = 0.57) and direct relationship with age (OR = 1.4).
TTD after a positive LDCT screen in the NLST showed a strong association with imaging features, stage and mortality.
• NLST observed variable time to lung cancer diagnosis from positive baseline screen. • Time to diagnosis was associated with imaging features, cancer type and stage. • In univariate but not multivariate analysis, longer TTD correlated with decreased mortality.
国家肺癌筛查试验（NLST）表明低剂量 CT（LDCT）筛查可降低肺癌和全因死亡率。本研究旨在检查 NLST 的 LDCT 组中肺癌的诊断时间（TTD），并评估其与癌症特征和生存的关系。
对 462 名基线筛查阳性且 3 年内确诊肺癌的患者进行数据和图像回顾，以确认基线异常。对病例进行分析，以确定 TTD 与影像学特征、癌症类型、分期和从基线筛查开始的 7 年生存之间的关系。
397/462 例病例在基线时被判断为存在癌症。与 TTD 显著相关（p 值趋势小于 0.05）的因素包括结节较小、纯磨玻璃结节（GGN）、光滑/分叶状边缘、I/II 期、腺癌和肺癌死亡率降低。肺癌死亡的逻辑回归模型显示，结节小于 20mm（OR=0.32）、纯 GGN（OR=0.24）、腺癌（OR=0.57）与 TTD 呈显著负相关，与年龄呈直接相关（OR=1.4）。
NLST 中阳性 LDCT 筛查后的 TTD 与影像学特征、分期和死亡率有很强的关联。
NLST 观察到从阳性基线筛查到肺癌诊断的时间有差异。
诊断时间与影像学特征、癌症类型和分期有关。
在单变量分析中，但不是在多变量分析中，较长的 TTD 与死亡率降低相关。
