Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
Chest. 2022 Sep;162(3):721-729. doi: 10.1016/j.chest.2022.03.031. Epub 2022 Mar 29.
Relatively little is known about various aspects of low-dose CT (LDCT) scan lung cancer screening in US clinical practice, including characteristics of cases diagnosed after screening. We assessed this using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.
What were the characteristics of patients with lung cancer, including stage and survival, whose disease was diagnosed after LDCT scan screenings?
We created an LDCT scan use cohort consisting of everyone in the 5% SEER-Medicare sample with ≥ 12 months of non-health maintenance organization (HMO) Part A and B coverage while 65 to 77 years of age from 2015 through 2019. LDCT scan use and lung cancer diagnosis rates were assessed in this cohort. Additionally, we created a lung cancer cohort consisting of patients who received a diagnosis between 2015 and 2017 at 65 to 78 years of age with complete (non-HMO Part A and B) coverage the year before diagnosis. The cases cohort comprised those screened or unscreened based on undergoing screening during that period; lung cancer characteristics and survival were compared between these groups.
In the LDCT scan use cohort (n = 414,358), use rates increased from 0.10 (per 100 person-years) in 2015 to 1.3 in 2019. Among those with first screenings, 39.2% underwent a subsequent screen within 18 months. The 1-year cumulative lung cancer diagnosis rate after initial screenings was 2.4%. Claims for prescreen counseling were infrequent (about 10%). Of 48,891 patients in the lung cancer cohort, 1,150 (2.4%) underwent screening. Among screened patients, 52.3%, 11.0%, 20.7%, and 16.0% received diagnoses of stages I, II, III, and IV disease, respectively. Lung cancer-specific survival through 3 years was significantly greater in screened versus unscreened patients overall and for all stages except stage II; 3-year lung cancer-specific survival was 89.0% in screened patients with stage I disease.
LDCT scan use was low but increased over time. The lung cancer yield was substantial; cases among those who underwent screening primarily were in the early stage with high survival rates. Although screening rates were unacceptably low, screening outcomes in those Medicare recipients undergoing screening were favorable.
在美国的临床实践中，对于低剂量 CT（LDCT）扫描肺癌筛查的各个方面，包括筛查后诊断出的病例特征，人们了解甚少。我们使用监测、流行病学和最终结果（SEER）-医疗保险数据库对此进行了评估。
通过 LDCT 扫描筛查诊断出的肺癌患者的特征，包括分期和生存情况如何？
我们创建了一个 LDCT 扫描使用队列，该队列由 2015 年至 2019 年期间，在 SEER-医疗保险样本中，年龄在 65 至 77 岁之间、至少有 12 个月非健康维护组织（HMO）A 部分和 B 部分覆盖的人群中，≥12 个月非 HMO A 部分和 B 部分覆盖的人群组成。在该队列中评估了 LDCT 扫描的使用情况和肺癌的诊断率。此外，我们创建了一个肺癌队列，该队列由在 65 至 78 岁之间在诊断前一年完全（非 HMO A 部分和 B 部分）覆盖的人群组成，他们在 2015 年至 2017 年期间接受了诊断，并在诊断前的那段时间内进行了筛查。病例队列是基于在这段时间内进行了筛查或未进行筛查而确定的；比较了这些组之间的肺癌特征和生存情况。
在 LDCT 扫描使用队列（n=414358）中，使用率从 2015 年的 0.10（每 100 人年）增加到 2019 年的 1.3。在首次筛查中，39.2%的人在 18 个月内进行了后续筛查。首次筛查后 1 年的肺癌累积诊断率为 2.4%。进行筛查前咨询的申请很少（约 10%）。在 48891 名肺癌队列患者中，有 1150 名（2.4%）进行了筛查。在接受筛查的患者中，分别有 52.3%、11.0%、20.7%和 16.0%的患者诊断为 I 期、II 期、III 期和 IV 期疾病。总体而言，在所有阶段（除 II 期外）和所有阶段，筛查组的肺癌特异性生存率显著高于未筛查组；I 期疾病患者的 3 年肺癌特异性生存率为 89.0%。
LDCT 扫描的使用虽然较低，但随着时间的推移而增加。肺癌的检出率很高；在接受筛查的人群中，主要为早期病例，且生存率较高。尽管筛查率低得不可接受，但在接受筛查的医疗保险受助人中，筛查结果良好。
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