Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
Int J Cancer. 2021 Jul 1;149(1):58-65. doi: 10.1002/ijc.33522. Epub 2021 Mar 20.
Screening for lung cancer (LC) by low-dose computed tomography (LDCT) has been demonstrated to reduce LC mortality in randomized clinical trials (RCTs), and its implementation is in preparation in many countries. However, definition of the target population, which was based on various combinations of age ranges and definitions of heavy smoking in the RCTs, is subject to ongoing debate. Using epidemiological data from Germany, we aimed to estimate prevalence of preclinical LC and positive predictive value (PPV) of LDCT in potential target populations defined by age and smoking history. Populations aged 50 to 69, 55 to 69, 50 to 74 and 55 to 79 years were considered in this analysis. Sex-specific prevalence of preclinical LC was estimated using LC incidence data within those age ranges and annual transition rates from preclinical to clinical LC obtained by meta-analysis. Prevalence of preclinical LC among heavy smokers (defined by various pack-year thresholds) within those age ranges was estimated by combining LC prevalence in the general population with proportions of heavy smokers and relative risks for LC among them derived from epidemiological studies. PPVs were calculated by combining these prevalences with sensitivity and specificity estimates of LDCT. Estimated prevalence of LC was 0.3% to 0.5% (men) and 0.2% to 0.3% (women) in the general population and 0.8% to 1.7% in target populations of heavy smokers. Estimates of PPV of LDCT were <20% for all definitions of target populations of heavy smokers. Refined preselection of target populations would be highly desirable to increase PPV and efficiency of LDCT screening and to reduce numbers of false-positive LDCT findings.
通过低剂量计算机断层扫描（LDCT）对肺癌（LC）进行筛查已在随机临床试验（RCT）中证明可降低 LC 的死亡率，并且许多国家都在准备实施这种筛查。然而，基于 RCT 中年龄范围和重度吸烟定义的各种组合来定义目标人群，这一做法仍存在争议。本研究利用德国的流行病学数据，旨在根据年龄和吸烟史，估计潜在目标人群中临床前 LC 的患病率和 LDCT 的阳性预测值（PPV）。本分析考虑了年龄在 50 至 69 岁、55 至 69 岁、50 至 74 岁和 55 至 79 岁的人群。使用这些年龄范围内的 LC 发病率数据以及通过荟萃分析获得的从临床前到临床 LC 的年度转移率来估计女性和男性临床前 LC 的患病率。通过将一般人群中的 LC 患病率与流行病学研究中得出的重度吸烟者的比例以及他们的 LC 相对风险相结合，来估计这些年龄范围内重度吸烟者（通过各种吸烟包年阈值定义）的临床前 LC 患病率。通过将这些患病率与 LDCT 的敏感性和特异性估计相结合来计算 PPV。估计的 LC 患病率在一般人群中为 0.3%至 0.5%（男性）和 0.2%至 0.3%（女性），在重度吸烟者的目标人群中为 0.8%至 1.7%。对于所有重度吸烟者的目标人群定义，LDCT 的估计 PPV 均<20%。高度期望对目标人群进行精细的预筛选，以提高 LDCT 筛查的 PPV 和效率，并减少 LDCT 假阳性结果的数量。
