Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
Respir Med. 2021 Nov;188:106610. doi: 10.1016/j.rmed.2021.106610. Epub 2021 Sep 21.
This study identifies participants ineligible for lung cancer screening with the greatest likelihood of future eligibility. Lung cancer risk in participants enrolled in longitudinal lung screening was assessed using the Prostate, Lung, Colorectal and Ovarian lung cancer risk calculator (PLCO) at two timepoints: baseline (T) and follow-up (T). Separate analyses were performed on four PLCO eligibility thresholds (3.25%, 2.00%, 1.50%, and 1.00%); only participants with a T risk less than the threshold were included in that analysis. Cox-models identified T risk factors associated with screen-eligibility at T. Three models, applying differing assumptions of participant behavior, predicted future eligibility and were benchmarked against the observed cohort. Nine hundred and fifty-six participants had a T risk <3.25%; at 2.00% n= 755; at 1.50% n= 652; at 1.00% n= 484. Lung cancer risk increased over time in most screen-ineligible participants. However, risk increased much faster in participants who became screen-eligible at T compared to those who remained screen-ineligible (median per-year increase of 0.35% versus 0.02%, when using a 3.25% threshold). Participants smoking for >30 years, current smokers, less educated participants, and those with chronic obstructive pulmonary disease (COPD) at T were significantly more likely to become screen-eligible. New diagnoses of COPD and/or non-lung cancers between T and T precipitated eligibility in a subset of participants. The prediction model that assumed health behaviors observed at T continued to T reasonably predicted changes in lung cancer risk. This prediction model and the identified baseline risk factors can identify screen-ineligible participants who should be closely followed for future eligibility.
本研究确定了最有可能在未来符合条件的不符合肺癌筛查条件的参与者。在两个时间点（基线[T]和随访[T]）使用前列腺癌、肺癌、结直肠癌和卵巢癌风险计算器（PLCO）评估了参加纵向肺部筛查的参与者的肺癌风险。在四个 PLCO 合格性阈值（3.25%、2.00%、1.50%和 1.00%）上分别进行了单独的分析；只有 T 风险低于阈值的参与者才被纳入该分析。Cox 模型确定了与 T 时的筛选资格相关的 T 风险因素。三个模型应用了不同的参与者行为假设，预测了未来的资格，并与观察队列进行了基准测试。956 名参与者的 T 风险<3.25%；在 2.00%时 n=755；在 1.50%时 n=652；在 1.00%时 n=484。在大多数不符合筛查条件的参与者中，肺癌风险随时间增加。然而，与那些一直不符合筛查条件的参与者相比，在 T 时变得符合筛查条件的参与者的风险增加得更快（当使用 3.25%的阈值时，每年中位数增加 0.35%与 0.02%）。在 T 时吸烟>30 年、当前吸烟者、受教育程度较低的参与者和患有慢性阻塞性肺疾病（COPD）的参与者更有可能变得符合筛查条件。在 T 和 T 之间诊断出 COPD 和/或非肺癌会使一部分参与者获得资格。假设在 T 时观察到的健康行为持续到 T 的预测模型合理地预测了肺癌风险的变化。该预测模型和确定的基线风险因素可以识别出不符合筛查条件但应密切关注未来资格的参与者。
