Yang Huiqin, Varley-Campbell Jo, Coelho Helen, Long Linda, Robinson Sophie, Snowsill Tristan, Griffin Ed, Peters Jaime, Hyde Chris
1Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK.
2Exeter Test Group, University of Exeter Medical School, Exeter, UK.
Diagn Progn Res. 2019 Nov 28;3:23. doi: 10.1186/s41512-019-0067-4. eCollection 2019.
Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early.
Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analysis. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed.
Four RCTs were included. More will provide data in the future. Meta-analysis demonstrated that LDCT screening with up to 9.80 years of follow-up was associated with a statistically non-significant decrease in lung cancer mortality (pooled relative risk (RR) 0.94, 95% confidence interval (CI) 0.74 to 1.19; = 0.62). There was a statistically non-significant increase in all-cause mortality. Given the considerable heterogeneity for both outcomes, the results should be treated with caution.Network meta-analysis including the four original RCTs plus two further RCTs assessed the relative effectiveness of LDCT, CXR and usual care. The results showed that in terms of lung cancer mortality reduction LDCT was ranked as the best screening strategy, CXR screening as the worst strategy and usual care intermediate.
LDCT screening may be effective in reducing lung cancer mortality but there is considerable uncertainty: the largest of the RCTs compared LDCT with CXR screening rather than no screening; there is imprecision of the estimates; and there is important heterogeneity between the included study results. The uncertainty about the effect on all-cause mortality is even greater. Maturing trials may resolve the uncertainty.
肺癌诊断通常在疾病晚期进行。低剂量计算机断层扫描（LDCT）能够早期检测出肺癌。
我们的目的是评估LDCT肺癌筛查对高危人群死亡率的影响。对比较LDCT筛查方案与常规护理（无筛查）或其他影像筛查方案（如胸部X线（CXR））的随机对照试验（RCT）进行了系统评价。CXR筛查的RCT也被纳入网络荟萃分析。检索了截至2017年1月的MEDLINE、Embase、Web of Science和Cochrane图书馆等文献来源。所有关键的综述步骤均由两人完成。质量评估采用Cochrane偏倚风险工具。进行了荟萃分析。
纳入了四项RCT。未来会有更多研究提供数据。荟萃分析表明，长达9.80年随访的LDCT筛查与肺癌死亡率的统计学非显著降低相关（合并相对风险（RR）0.94，95%置信区间（CI）0.74至1.19；P = 0.62）。全因死亡率有统计学非显著增加。鉴于这两个结果存在相当大的异质性，结果应谨慎对待。包括四项原始RCT以及另外两项RCT的网络荟萃分析评估了LDCT、CXR和常规护理的相对有效性。结果显示，就降低肺癌死亡率而言，LDCT被列为最佳筛查策略，CXR筛查为最差策略，常规护理居中。
LDCT筛查可能有效降低肺癌死亡率，但存在相当大的不确定性：最大的RCT将LDCT与CXR筛查进行了比较，而非与无筛查进行比较；估计值不精确；纳入的研究结果之间存在重要的异质性。对全因死亡率影响的不确定性甚至更大。正在进行的试验可能会解决这些不确定性。
