Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Lung Cancer. 2020 Nov;149:113-119. doi: 10.1016/j.lungcan.2020.09.013. Epub 2020 Sep 23.
As low-dose CT screening is gaining acceptance, focus is on increasing the efficiency of screening. One major consideration is to reduce the total number of annual rounds by increasing the interval between screening rounds. It has been suggested that longer intervals could be used for individuals who are at lower risk of lung cancer. In this study, we explored whether eligible participants in a program of LDCT screening who are at lower risk of lung cancer have less aggressive cancers than those at higher risk.
We retrospectively identified 118 participants in I-ELCAP database between 1992-2019 who had been screened using HIPAA-compliant protocols and had solid lung cancers diagnosed on an annual round of screening, 7-18 months after the prior round. Volume doubling time (VDT) for each cancer was calculated. Estimated risk of developing lung cancer was calculated using PLCO model. The strength of the relationship between VDT and individual PLCO scores was assessed by Pearson(r) and Spearman (ρ) correlation coefficients.
VDTs were significantly different by cell-type (p < 0.0001); median VDT for small cell was 34.0 days, followed by other cell-types (61.8 days), squamous-cell (73.3 days), and adenocarcinoma (135.7 days). The median VDT for the 78 (66.1 %) Stage I lung cancers was significantly longer than the 40 Stage II + lung cancers (101.4 days vs. 45.5 days, p < 0.0001). None of the established lung cancer risk indicators (age, pack-years of smoking, or PLCO scores) were significant predictors of VDT or lung cancer stage.
No significant relationship was demonstrated between risk of developing lung cancer (measured by risk models, age or smoking history) and lung cancer aggressiveness (measured by VDT, cell-type and Stage). This suggests that there is no evidence for determining intervals between repeat screenings using risk-based characteristics. It does not, however, exclude the possibility that future models may establish such a relationship.
随着低剂量 CT 筛查的接受程度不断提高，人们越来越关注提高筛查效率。一个主要考虑因素是通过增加筛查轮次的间隔来减少每年的轮次总数。有人建议，对于肺癌风险较低的个体，可以使用更长的间隔时间。在这项研究中，我们探讨了在 LDCT 筛查计划中，肺癌风险较低的合格参与者的癌症是否比肺癌风险较高的参与者的癌症侵袭性更小。
我们回顾性地从 1992 年至 2019 年的 I-ELCAP 数据库中确定了 118 名参与者，他们使用符合 HIPAA 规定的方案进行了筛查，并在之前一轮筛查后 7-18 个月在年度筛查中诊断出实体肺癌。计算每个癌症的倍增时间（VDT）。使用 PLCO 模型计算发生肺癌的估计风险。通过 Pearson(r) 和 Spearman (ρ) 相关系数评估 VDT 与个体 PLCO 评分之间的关系强度。
细胞类型之间的 VDT 差异有统计学意义（p<0.0001）；小细胞的中位 VDT 为 34.0 天，其次是其他细胞类型（61.8 天）、鳞状细胞（73.3 天）和腺癌（135.7 天）。78 例（66.1%）I 期肺癌的中位 VDT 明显长于 40 例 II 期+肺癌（101.4 天与 45.5 天，p<0.0001）。已建立的肺癌风险指标（年龄、吸烟包年数或 PLCO 评分）均不能预测 VDT 或肺癌分期。
未发现发展为肺癌的风险（通过风险模型、年龄或吸烟史来衡量）与肺癌侵袭性（通过 VDT、细胞类型和分期来衡量）之间存在显著关系。这表明，没有证据表明可以使用基于风险的特征来确定重复筛查之间的间隔。然而，这并不排除未来的模型可能会建立这种关系的可能性。
