Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Clin Lung Cancer. 2018 Sep;19(5):e767-e773. doi: 10.1016/j.cllc.2018.05.019. Epub 2018 Jun 5.
The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer-related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS-led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community.
Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS-eligible patients based on screening completion. Survival analyses were conducted using Kaplan-Meier and multivariate Cox regression.
In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow-up in-network cancer treatment (P = .03), and surgical management (P < .01). LCS-eligible patients who underwent screening had improved all-cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality.
To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen-detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS-led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.
具有里程碑意义的全国肺癌筛查试验表明，肺癌相关死亡率显著降低。然而，欧洲的肺癌筛查（LCS）试验并未证实这一益处。我们检查了 LCS 模式，并确定了在服务不足的社区中，LCS 引导诊断对新诊断的肺癌患者死亡率的影响。
回顾了 2013 年至 2016 年期间诊断为原发性肺癌的患者的医疗记录（n=855），以确定初级保健提供者（PCP）的状况和使用美国预防服务工作组指南确定的 LCS 资格和完成情况。根据筛查完成情况，对 LCS 合格患者的患者特征进行了单变量分析。使用 Kaplan-Meier 和多变量 Cox 回归进行生存分析。
2013 年至 2016 年，有 175 名原发性肺癌患者有固定的 PCP 并符合 LCS 条件。其中，19%（33/175）在诊断前完成了筛查。LCS 完成情况与年龄较小（P=0.02）、当前吸烟状态（P<0.01）、诊断时较早的分期（P<0.01）、网络内癌症治疗的随访（P=0.03）和手术治疗（P<0.01）相关。接受筛查的 LCS 合格患者的全因死亡率低于未接受筛查的患者（P<0.01）。多变量回归显示手术（风险比，0.31；P=0.04）显著影响死亡率。
据我们所知，这是自美国预防服务工作组指南发布以来，在城市服务不足的环境中评估 LCS 模式和筛查发现的肺癌患者死亡率差异的第一项研究。接受 LCS 引导诊断的患者死亡率有所改善，这可能是由于更早阶段进行癌症检测并进行了治愈性治疗，这与前瞻性试验的结果一致。
