CT 筛查检出的小细胞肺癌的特征和结局。
Characteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening.
机构信息
Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD.
出版信息
Chest. 2018 Dec;154(6):1284-1290. doi: 10.1016/j.chest.2018.07.029. Epub 2018 Aug 3.
BACKGROUND
Previous studies with a limited number of patients have reported divergent findings on whether screening can detect small cell lung cancer (SCLC) at an earlier stage and whether there might be a survival benefit.
METHODS
This study examined the characteristics of SCLC detected by using low-dose CT (LDCT) screening in the National Lung Screening Trial, a randomized study of individuals at high risk for developing lung cancer comparing LDCT imaging vs chest radiography. SCLC was denoted as screen detected if diagnosed ≤ 1 year of a positive screen or after a longer period but with no time gap between diagnostic procedures of > 1 year; interval detected if diagnosed ≤ 1 year of a negative screen; and nonscreen detected if the subject did not receive any screens or otherwise as postscreening.
RESULTS
A total of 143 cases of SCLC were diagnosed, including 49 (34.2%) screen detected, 15 (10.5%) interval detected, and 79 (55.2%) nonscreened/postscreening. Of the screening phase-diagnosed cases (ie, screen or interval detected), a higher proportion of SCLC cases compared with NSCLC cases were interval detected (23% vs 5%; P < .0001). A higher proportion of all SCLC cases compared with NSCLC cases were advanced stage (III/IV: 86% vs 36%; P < .0001). The unfavorable SCLC stage distribution extended across screen-detected (80% stage III/IV), interval-detected (86%), and nonscreened/postscreening (90%) cancers. Among screen-detected SCLC, only 63.3% had ≥ 1 noncalcified nodule in the cancer lobe compared with 85.4% of NSCLC cases (P < .0001). Even with very small LDCT screen-detected nodules, a high proportion of SCLC cases were late stage. There was no significant difference in survival between screen- and interval-detected or postscreening SCLC.
CONCLUSIONS
"Early detection" with the use of LDCT imaging had no impact on SCLC outcomes. A successful screening modality should ideally detect SCLC earlier than when it can be detected on LDCT scans.
背景
此前一些针对少量患者开展的研究报告称，筛查能否更早发现小细胞肺癌（SCLC）以及是否可能带来生存获益，结果不一。
方法
本研究通过国家肺癌筛查试验（National Lung Screening Trial）中使用低剂量 CT（LDCT）筛查发现的 SCLC 特征进行了研究。该试验为一项随机研究，比较了 LDCT 成像与胸部 X 线摄影对高危肺癌患者的效果。如果在阳性筛查结果后 1 年内确诊，或在更久后确诊但两次诊断之间无间隔超过 1 年，则将 SCLC 定义为筛查发现；如果在阴性筛查结果后 1 年内确诊，则将 SCLC 定义为间隔发现；如果患者未接受任何筛查或在筛查后被诊断，则将 SCLC 定义为未筛查/筛查后发现。
结果
共诊断出 143 例 SCLC，其中 49 例（34.2%）为筛查发现，15 例（10.5%）为间隔发现，79 例（55.2%）为未筛查/筛查后发现。与非小细胞肺癌（NSCLC）病例相比，筛查期诊断的 SCLC 病例中，间隔发现的比例更高（23%比 5%；P<.0001）。所有 SCLC 病例中，与 NSCLC 病例相比，晚期病例比例更高（III/IV 期：86%比 36%；P<.0001）。不利的 SCLC 分期分布延伸至筛查发现（80%为 III/IV 期）、间隔发现（86%）和未筛查/筛查后发现（90%）的癌症中。在筛查发现的 SCLC 中，仅有 63.3%的癌症叶中存在≥1 个非钙化结节，而 NSCLC 病例中这一比例为 85.4%（P<.0001）。即使 LDCT 筛查发现的结节非常小，SCLC 病例仍有很高的晚期比例。筛查发现和间隔发现或筛查后发现的 SCLC 之间的生存无显著差异。
结论
使用 LDCT 成像的“早期检测”对 SCLC 结局没有影响。理想情况下，有效的筛查方式应能更早发现 SCLC，而不是只能在 LDCT 扫描中发现。
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