Lee Jonathan S, Lisker Sarah, Vittinghoff Eric, Cherian Roy, McCoy David B, Rybkin Alex, Su George, Sarkar Urmimala
Division of General Internal Medicine, University of California, San Francisco, CA 94143-0320, USA.
Center for Vulnerable Populations, University of California, San Francisco, CA 94143-0320, USA.
Diagnosis (Berl). 2019 Nov 26;6(4):351-359. doi: 10.1515/dx-2019-0008.
Background Though incidental pulmonary nodules are common, rates of guideline-recommended surveillance and associations between surveillance and mortality are unclear. In this study, we describe adherence (categorized as complete, partial, late and none) to guideline-recommended surveillance among patients with incidental 5-8 mm pulmonary nodules and assess associations between adherence and mortality. Methods This was a retrospective cohort study of 551 patients (≥35 years) with incidental pulmonary nodules conducted from September 1, 2008 to December 31, 2016, in an integrated safety-net health network. Results Of the 551 patients, 156 (28%) had complete, 87 (16%) had partial, 93 (17%) had late and 215 (39%) had no documented surveillance. Patients were followed for a median of 5.2 years [interquartile range (IQR), 3.6-6.7 years] and 82 (15%) died during follow-up. Adjusted all-cause mortality rates ranged from 2.24 [95% confidence interval (CI), 1.24-3.25] deaths per 100 person-years for complete follow-up to 3.30 (95% CI, 2.36-4.23) for no follow-up. In multivariable models, there were no statistically significant associations between the levels of surveillance and mortality (p > 0.16 for each comparison with complete surveillance). Compared with complete surveillance, adjusted mortality rates were non-significantly increased by 0.45 deaths per 100 person-years (95% CI, -1.10 to 2.01) for partial, 0.55 (95% CI, -1.08 to 2.17) for late and 1.05 (95% CI, -0.35 to 2.45) for no surveillance. Conclusions Although guideline-recommended surveillance of small incidental pulmonary nodules was incomplete or absent in most patients, gaps in surveillance were not associated with statistically significant increases in mortality in a safety-net population.
背景 虽然偶然发现的肺结节很常见，但指南推荐的监测率以及监测与死亡率之间的关联尚不清楚。在本研究中，我们描述了偶然发现的5-8毫米肺结节患者对指南推荐监测的依从性（分为完全、部分、延迟和无依从），并评估依从性与死亡率之间的关联。方法 这是一项对2008年9月1日至2016年12月31日在一个综合安全网健康网络中进行的551例（≥35岁）偶然发现肺结节患者的回顾性队列研究。结果 在551例患者中，156例（28%）进行了完全监测，87例（16%）进行了部分监测，93例（17%）进行了延迟监测，215例（39%）没有记录在案的监测。患者的中位随访时间为5.2年[四分位间距（IQR），3.6-6.7年]，82例（15%）在随访期间死亡。调整后的全因死亡率范围从完全随访时的每100人年2.24例[95%置信区间（CI），1.24-3.25]死亡到无随访时的3.30例（95%CI，2.36-4.23）。在多变量模型中，监测水平与死亡率之间没有统计学上的显著关联（与完全监测的每次比较p>0.16）。与完全监测相比，部分监测的调整后死亡率每100人年非显著增加0.45例死亡（95%CI，-1.10至2.01），延迟监测增加0.55例（95%CI，-1.08至2.17），无监测增加1.05例（95%CI，-0.35至2.45）。结论 虽然大多数患者对指南推荐的小偶然肺结节监测不完整或未进行，但在安全网人群中，监测差距与死亡率的统计学显著增加无关。
