Tang Xue, Qu Guangbo, Wang Lingling, Wu Wei, Sun Yehuan
. Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, China.
. Centre for Evidence-Based Practice, Anhui Medical University, Hefei 230032, China.
Rev Assoc Med Bras (1992). 2019 Dec;65(12):1508-1514. doi: 10.1590/1806-9282.65.12.1508.
Lung cancer is the leading cause of cancer-related death. To reduce lung cancer mortality and detect lung cancer in early stages, low dose CT screening is required. A meta-analysis was conducted to verify whether screening could reduce lung cancer mortality and to determine the optimal screening program.
We searched PubMed, Web of Science, Cochrane library, ScienceDirect, and relevant Chinese databases. Randomized controlled trial studies with participants that were smokers older than 49 years (smoking >15 years or quit smoking 10 or 15 years ago) were included.
Nine RCT studies met the criteria. LDCT screening could find more lung cancer cases (RR=1.58, 95%CI=1.25-1.99, P<0.001) and more stage I lung cancers (RR=3.45, 95%CI=2.08-5.72, P<0.001) compared to chest-X ray or the no screening group. This indicated a statistically significant reduction in lung-cancer-specific mortality (RR=0.84, 95%CI=0.75-0.95, P=0.004), but without a statistically reduction in mortality due to all causes (RR=1.26, 95%CI=0.89-1.78, P=0.193). Annually, LDCT screening was sensitive in finding more lung cancers.
Low-dose CT screening is effective in finding more lung cancer cases and decreasing the deaths from lung cancer. Annual low-dose CT screening may be better than a biennial screening to detect more early-stage lung cancer cases.
肺癌是癌症相关死亡的主要原因。为降低肺癌死亡率并早期发现肺癌，需要进行低剂量CT筛查。进行一项荟萃分析以验证筛查是否能降低肺癌死亡率并确定最佳筛查方案。
我们检索了PubMed、科学网、考克兰图书馆、ScienceDirect以及相关中文数据库。纳入了针对年龄大于49岁的吸烟者（吸烟超过15年或在10或15年前戒烟）的随机对照试验研究。
9项随机对照试验研究符合标准。与胸部X线或未筛查组相比，低剂量CT筛查能发现更多肺癌病例（相对危险度=1.58，95%置信区间=1.25 - 1.99，P<0.001）以及更多I期肺癌（相对危险度=3.45，95%置信区间=2.08 - 5.72，P<0.001）。这表明肺癌特异性死亡率有统计学显著降低（相对危险度=0.84，95%置信区间=0.75 - 0.95，P=0.004），但全因死亡率无统计学降低（相对危险度=1.26，95%置信区间=0.89 - 1.78，P=0.193）。每年进行低剂量CT筛查在发现更多肺癌方面较为敏感。
低剂量CT筛查在发现更多肺癌病例和降低肺癌死亡方面有效。每年进行低剂量CT筛查可能比两年一次的筛查更能发现更多早期肺癌病例。
