Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
Department of Radiology, National Jewish Health, Denver, CO.
Chest. 2022 Apr;161(4):1092-1100. doi: 10.1016/j.chest.2021.11.015. Epub 2021 Nov 25.
Incidental respiratory disease-related findings are frequently observed on low-dose CT (LDCT) lung cancer screenings. This study analyzed data from the National Lung Screening Trial (NLST) to assess the relationship between such findings and respiratory disease mortality (RDM), excluding lung cancer.
Are incidental respiratory findings on LDCT scanning associated with increased RDM?
Subjects in the NLST LDCT arm received three annual screens. Trial radiologists noted findings related to possible lung cancer, as well as respiratory-related incidental findings. Demographic characteristics, smoking history, and medical history were captured in a baseline questionnaire. Kaplan-Meier curves were used to assess cumulative RDM. Multivariate proportional hazards models were used to assess risk factors for RDM; in addition to incidental CT scan findings, variables included respiratory disease history (COPD/emphysema, and asthma), smoking history, and demographic factors (age, race, sex, and BMI).
Of 26,722 subjects in the NLST LDCT arm, 25,002 received the baseline screen and a subsequent LDCT screen. Overall, 59% were male, 26.5% were aged ≥ 65 years at baseline, and 10.6% reported a history of COPD/emphysema. Emphysema on LDCT scanning was reported in 30.7% of subjects at baseline and in 44.2% at any screen. Of those with emphysema on baseline LDCT scanning, 18% reported a history of COPD/emphysema. Median mortality follow-up was 10.3 years. There were 3,639 deaths, and 708 were from respiratory diseases. Among subjects with no history of COPD/emphysema, 10-year cumulative RDM ranged from 3.9% for subjects with emphysema and reticular opacities to 1.1% for those with neither condition; the corresponding range among subjects with a COPD/emphysema history was 17.3% (both) to 3.7% (neither). Emphysema on LDCT imaging was associated with a significantly elevated RDM hazard ratio (2.27; 95% CI, 1.92-2.7) in the multivariate model. Reticular opacities (including honeycombing/fibrosis/scar) also had a significantly elevated hazard ratio (1.39; 95% CI, 1.19-1.62).
Incidental respiratory disease-related findings observed on NLST LDCT screens were frequent and associated with increased mortality from respiratory diseases.
在低剂量 CT（LDCT）肺癌筛查中经常观察到偶然的与呼吸相关的疾病发现。本研究分析了国家肺癌筛查试验（NLST）的数据，以评估这些发现与排除肺癌后呼吸疾病死亡率（RDM）之间的关系。
LDCT 扫描上偶然的呼吸发现是否与 RDM 增加有关？
NLST LDCT 臂的受试者接受了三次年度筛查。试验放射科医生注意到与可能的肺癌以及与呼吸相关的偶然发现有关的发现。人口统计学特征、吸烟史和病史在基线问卷中进行了记录。使用 Kaplan-Meier 曲线评估累积 RDM。使用多变量比例风险模型评估 RDM 的危险因素；除了偶然的 CT 扫描发现外，变量还包括呼吸疾病史（COPD/肺气肿和哮喘）、吸烟史以及人口统计学因素（年龄、种族、性别和 BMI）。
NLST LDCT 臂的 26722 名受试者中，有 25002 名接受了基线筛查和随后的 LDCT 筛查。总体而言，59%为男性，26.5%在基线时年龄≥65 岁，10.6%报告有 COPD/肺气肿病史。基线 LDCT 扫描显示肺气肿的受试者占 30.7%，任何筛查时占 44.2%。在基线 LDCT 扫描有肺气肿的受试者中，有 18%报告有 COPD/肺气肿病史。中位随访死亡率为 10.3 年。共有 3639 人死亡，其中 708 人死于呼吸疾病。在没有 COPD/肺气肿病史的受试者中，10 年累积 RDM 范围为：有肺气肿和网状阴影的受试者为 3.9%，无这两种情况的受试者为 1.1%；在有 COPD/肺气肿病史的受试者中，这一范围为 17.3%（两者都有）至 3.7%（两者都没有）。LDCT 成像上的肺气肿与多变量模型中 RDM 风险比显著升高（2.27；95%CI，1.92-2.7）相关。网状阴影（包括蜂窝状/纤维化/瘢痕）也具有显著升高的风险比（1.39；95%CI，1.19-1.62）。
NLST LDCT 屏幕上观察到的偶然与呼吸相关的疾病发现很常见，与呼吸疾病死亡率的增加有关。
