肺癌筛查中头颈部癌的发病率：一项随机对照试验的二次分析。

Incidence of Head and Neck Cancer With Lung Cancer Screening: Secondary Analysis of a Randomized Controlled Trial.

机构信息

Wayne State University School of Medicine, Detroit, Michigan, U.S.A.

Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan, U.S.A.

出版信息

Laryngoscope. 2022 Aug;132(8):1609-1614. doi: 10.1002/lary.30006. Epub 2022 Jan 5.

DOI:10.1002/lary.30006

PMID:34984679

Abstract

OBJECTIVES/HYPOTHESIS: To evaluate the incidence of head and neck cancers (HNC) in high-risk current and/or former smokers with screening low-dose computed tomography (LDCT) chest versus chest x-ray (CXR).

STUDY DESIGN

Second analysis of randomized clinical trial.

METHODS

We performed a secondary analysis examining the incidence of HNC in the National Lung Screening Trial. This was a randomized trial comparing LDCT versus CXR screening for lung cancer detection in high-risk individuals (30 pack-year smokers who currently smoke or quit within the last 15 years, aged 55-74). We compared the incidence of HNC in participants screened with LDCT versus CXR. We performed subgroup analyses in participants with mucosal HNC (oral cavity, oropharynx, larynx, hypopharynx, nasal/sinus cavity, or nasopharynx) or nonmucosal HNC (thyroid or salivary gland) and examined survival in the two screening arms.

RESULTS

This trial enrolled 53,452 participants with a median follow-up of 6.2 years after randomization. The incidence of HNC was 111.8 cases per 100,000 person-years in the LDCT group versus 87.1 cases per 100,000 person-years in the CXR group (rate ratio 1.30, 95% confidence interval [CI] 1.05-1.61). There were 11.7 deaths from HNC per 100,000 person-years in the LDCT group and 12.9 deaths per 100,000 person-years in the CXR group (hazard ratio 0.80, 95% CI 0.42-1.52).

CONCLUSIONS

Participants screened with LDCT had a modestly higher incidence of HNC. As uptake and adherence of lung cancer screening guidelines improve, clinicians should recognize that incidental findings from screening may lead to increased detection of HNC.

LEVEL OF EVIDENCE

3 Laryngoscope, 132:1609-1614, 2022.

摘要

目的/假设：评估在接受筛查性低剂量计算机断层扫描（LDCT）胸部检查与胸部 X 射线（CXR）检查的高危现吸烟者和/或前吸烟者中头颈部癌症（HNC）的发病率。

研究设计

随机临床试验的二次分析。

方法

我们对国家肺癌筛查试验（National Lung Screening Trial）进行了二次分析，以研究 HNC 的发病率。这是一项随机试验，比较了 LDCT 与 CXR 筛查在高危人群（30 包年吸烟史，目前仍在吸烟或过去 15 年内已戒烟，年龄 55-74 岁）中肺癌检出率的差异。我们比较了接受 LDCT 与 CXR 筛查的参与者中 HNC 的发病率。我们对黏膜性 HNC（口腔、口咽、喉、下咽、鼻腔/鼻窦腔或鼻咽）或非黏膜性 HNC（甲状腺或唾液腺）患者进行了亚组分析，并检查了两个筛查组的生存率。

结果

该试验共纳入 53452 名参与者，随机分组后中位随访时间为 6.2 年。LDCT 组 HNC 的发病率为每 100000 人年 111.8 例，CXR 组为每 100000 人年 87.1 例（发生率比 1.30，95%置信区间 [CI] 1.05-1.61）。LDCT 组每 100000 人年有 11.7 例 HNC 死亡，CXR 组为每 100000 人年 12.9 例（风险比 0.80，95%CI 0.42-1.52）。