国家肺癌筛查试验中低剂量 CT 筛查后的患者水平轨迹和结局。
Patient-Level Trajectories and Outcomes After Low-Dose CT Screening in the National Lung Screening Trial.
机构信息
Pulmonary Center, Boston University School of Medicine, Boston, MA.
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
出版信息
Chest. 2019 Nov;156(5):965-971. doi: 10.1016/j.chest.2019.06.016. Epub 2019 Jul 5.
BACKGROUND
Shared decision-making is an essential element of low-dose CT (LDCT) screening for lung cancer. Understanding patient-level outcomes from the National Lung Screening Trial (NLST) is critical to effectively communicate risks and benefits of screening to patients.
METHODS
We performed a secondary analysis of data collected in the NLST. We determined outcomes of each LDCT scan performed in the NLST (downstream evaluation, complications, lung cancer diagnoses), and compared outcomes at the test level with outcomes calculated at the patient level for those randomized to LDCT screening. To assess the impact of COPD on patient outcomes, we compared outcomes among patients with and without COPD.
RESULTS
Of 75,138 LDCT scans, 14.2% led to a diagnostic study and 1.5% to an invasive procedure, with 0.3% of LDCT scans resulting in a procedure-related complication and 0.1% in a serious complication. Among 24,453 patients who underwent LDCT screening, 30.5% underwent a diagnostic study and 4.2% an invasive procedure, with 0.9% of screened patients experiencing a procedure-related complication and 0.3% a serious complication. Patients with COPD (defined by self-report) were more likely to need a diagnostic study (adjusted OR [aOR], 1.29; P < .01) and an invasive procedure (aOR, 1.41; P < .01) and more likely to experience a complication (aOR, 1.83; P < .01) and a serious complication (aOR, 1.78; P = .01). Patients with COPD also were more likely to be diagnosed with lung cancer (aOR, 1.43; P < .01).
CONCLUSIONS
We provide important patient-level data from the NLST that can be used to guide shared decision-making. The risk-to-benefit ratio of screening may vary significantly in some patients, such as those with COPD, in whom both risks and benefits of screening may be increased.
背景
共决是肺癌低剂量 CT（LDCT）筛查的一个重要组成部分。了解国家肺癌筛查试验（NLST）的患者水平结局对于向患者有效沟通筛查的风险和获益至关重要。
方法
我们对 NLST 中收集的数据进行了二次分析。我们确定了 NLST 中进行的每一次 LDCT 扫描的结果（下游评估、并发症、肺癌诊断），并将随机分配到 LDCT 筛查的患者的检测水平结果与患者水平结果进行了比较。为了评估 COPD 对患者结局的影响，我们比较了有和没有 COPD 的患者的结局。
结果
在 75138 次 LDCT 扫描中，14.2%导致诊断性研究，1.5%导致有创性程序，0.3%的 LDCT 扫描导致与程序相关的并发症，0.1%导致严重并发症。在 24453 名接受 LDCT 筛查的患者中，30.5%进行了诊断性研究，4.2%进行了有创性程序，0.9%的筛查患者发生了与程序相关的并发症，0.3%发生了严重并发症。有 COPD（通过自我报告定义）的患者更有可能需要进行诊断性研究（调整后的优势比 [aOR]，1.29；P<0.01）和有创性程序（aOR，1.41；P<0.01），更有可能发生并发症（aOR，1.83；P<0.01）和严重并发症（aOR，1.78；P=0.01）。有 COPD 的患者也更有可能被诊断为肺癌（aOR，1.43；P<0.01）。
结论
我们提供了来自 NLST 的重要患者水平数据，可用于指导共决。在某些患者中，如 COPD 患者，筛查的风险-获益比可能有显著差异，这些患者的筛查风险和获益可能都增加。
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