低剂量计算机断层扫描筛查中中央型和周围型肺癌的检测模式、特征及结果差异

Differences in detection patterns, characteristics, and outcomes of central and peripheral lung cancers in low-dose computed tomography screening.

作者信息

Kim Yeon Wook, Jeon Minhee, Song Myung Jin, Kwon Byoung Soo, Lim Sung Yoon, Lee Yeon Joo, Park Jong Sun, Cho Young-Jae, Yoon Ho Il, Lee Kyung Won, Lee Jae Ho, Lee Choon-Taek

机构信息

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

出版信息

Transl Lung Cancer Res. 2021 Nov;10(11):4185-4199. doi: 10.21037/tlcr-21-658.

DOI:10.21037/tlcr-21-658

PMID:35004249

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8674608/

Abstract

BACKGROUND

Although low-dose computed tomography (LDCT) screening is known to be effective for the detection of lung cancers localized in peripheral lung regions at a curable stage, limited data is available regarding the characteristics and outcomes of central lung cancers diagnosed in a screening cohort. This study aimed to determine whether LDCT screening could effectively detect central lung cancers at an early stage and offer survival benefits.

METHODS

We analyzed 52,615 adults who underwent lung cancer screening with LDCT between May 2003 and Dec 2019 at a tertiary center in South Korea. Characteristics and outcomes of those diagnosed with lung cancer, stratified by screen-detection status and cancer location, were evaluated.

RESULTS

A total of 352 individuals (281 screen-detected, 71 non-screen-detected) were diagnosed with lung cancer. Compared to screen-detected cancers, non-screen-detected cancers tended to be centrally-located (11.4% vs. 64.8%, P<0.001). Most non-screen-detected central cancers (89.1%) had a negative result on prior LDCT screening. Multivariable regression analyses revealed that for peripheral cancers, screen-detection was associated with a significantly lower probability of diagnosis at an advanced stage [III/IV, odds ratio (OR) =0.15, 95% confidence interval (CI): 0.05-0.45] and mortality [hazard ratio (HR) =0.33, 95% CI: 0.13-0.84]; however, the association was insignificant for central cancers. For screen-detected cancers, central location, compared to peripheral location, was significantly associated with a higher risk of diagnosis at an advanced stage (OR =20.83, 95% CI: 6.67-64.98) and mortality (HR =4.98, 95% CI: 2.26-10.97).

CONCLUSIONS

Unlike for peripheral cancers, LDCT screening did not demonstrate an improvement in outcomes of central lung cancers, indicating an important limitation of LDCT screening and the need for developing novel modalities to screen and treat central lung cancer.

摘要

背景

尽管低剂量计算机断层扫描（LDCT）筛查已知对检测处于可治愈阶段的外周肺区域肺癌有效，但关于在筛查队列中诊断出的中央型肺癌的特征和结果的数据有限。本研究旨在确定LDCT筛查是否能有效早期检测中央型肺癌并提供生存益处。

方法

我们分析了2003年5月至2019年12月期间在韩国一家三级中心接受LDCT肺癌筛查的52,615名成年人。评估了那些被诊断为肺癌的患者的特征和结果，按筛查检测状态和癌症位置进行分层。

结果

共有352人（281人通过筛查检测出，71人未通过筛查检测出）被诊断为肺癌。与通过筛查检测出的癌症相比，未通过筛查检测出的癌症往往位于中央（11.4%对64.8%，P<0.001）。大多数未通过筛查检测出的中央型癌症（89.1%）在先前的LDCT筛查中结果为阴性。多变量回归分析显示，对于外周型癌症，筛查检测与晚期诊断的概率显著降低相关[III/IV期，比值比（OR）=0.15，95%置信区间（CI）：0.05 - 0.45]和死亡率[风险比（HR）=0.33，95%CI：0.13 - 0.84]；然而，对于中央型癌症，这种关联不显著。对于通过筛查检测出的癌症，与外周位置相比，中央位置与晚期诊断风险更高（OR =20.83，95%CI：6.67 - 64.98）和死亡率更高（HR =4.98，95%CI：2.26 - 10.97）显著相关。