Lineberger Cancer Comprehensive Center, University of North Carolina at Chapel Hill.
Division of Pulmonary and Critical Care, University of Rochester Medical Center, Rochester, New York.
JAMA Netw Open. 2022 Sep 1;5(9):e2230146. doi: 10.1001/jamanetworkopen.2022.30146.
Comorbidities characterize the underlying health status of individuals. In the context of lung cancer screening (LCS), lung-related comorbidities may influence the observed benefits and harms.
To compare the characteristics of individuals undergoing LCS, the LCS examination result, the cancer detection rate (CDR), and the false-positive rate (FPR) in those with and without lung-related comorbidities.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted in 5 academic and community screening sites across North Carolina from January 1, 2014, to November 7, 2020. Participants included 611 individuals screened for lung cancer who completed a 1-page health history questionnaire.
Presence of at least 1 self-reported lung-related comorbidity, including chronic obstructive pulmonary disease, chronic bronchitis, emphysema, asthma, bronchiectasis, pulmonary fibrosis, silicosis, asbestosis, sarcoidosis, and tuberculosis.
The LCS examination result was determined from the radiologist's Lung Imaging Reporting and Data System assessment (negative, 1 or 2; positive, 3 or 4). The age-adjusted CDR and FPR were calculated per 100 LCS examinations, using binary logistic regression.
Among the 611 individuals screened for lung cancer (308 men [50.4%]; mean [SD] age, 64 [6.2] years), 335 (54.8%) had at least 1 lung-related comorbidity. Individuals with vs without lung-related comorbidities were more likely to be female than male (180 of 335 [53.7%] vs 123 of 276 [44.6%]; P = .02), White vs non-White race (275 of 326 [84.4%] vs 193 of 272 [71.0%]; P < .001), and have high school or less education vs greater than a high school education (108 of 231 [46.7%] vs 64 of 208 [30.8%]; P = .001). There were no significant differences in the proportion of positive LCS examinations in those with vs without a lung-related comorbidity at baseline (37 [16.0%] vs 22 [11.1%]; P = .14) or subsequent (40 [12.3%] vs 23 [10.6%]; P = .54) LCS examination. Comparing individuals with vs without lung-related comorbidities, there was no statistically significant difference in the CDR (1.6 vs 1.9 per 100; P = .73) or FPR (13.0 vs 9.3 per 100; P = .16). Of the 17 individuals with lung cancer, 13 patients (76.5%) were diagnosed with stage I lung cancer.
The findings of this study suggest that individuals with self-reported lung-related comorbidities undergoing LCS were more likely to be female, of White race, and have less education than those without lung-related comorbidity. Although no statistically significant differences in the proportion of positive examinations, CDR, or FPR by self-reported lung comorbidities were noted, additional studies with larger numbers of individuals undergoing screening are needed to understand LCS outcomes in those with lung-related comorbidities.
合并症是个体基础健康状况的特征。在肺癌筛查（LCS）的背景下，肺部相关合并症可能会影响观察到的获益和危害。
比较接受 LCS 的个体的特征、LCS 检查结果、癌症检出率（CDR）和假阳性率（FPR），这些个体有或没有肺部相关合并症。
设计、地点和参与者：这是一项前瞻性队列研究，在北卡罗来纳州的 5 个学术和社区筛查点进行，时间从 2014 年 1 月 1 日至 2020 年 11 月 7 日。参与者包括 611 名接受肺癌筛查的个体，他们完成了一份 1 页的健康史问卷。
存在至少 1 种自我报告的肺部相关合并症，包括慢性阻塞性肺疾病、慢性支气管炎、肺气肿、哮喘、支气管扩张症、肺纤维化、矽肺、石棉肺、结节病和肺结核。
LCS 检查结果由放射科医生的肺部成像报告和数据系统评估确定（阴性，1 或 2；阳性，3 或 4）。根据二项逻辑回归计算每 100 次 LCS 检查的年龄调整后的 CDR 和 FPR。
在接受肺癌筛查的 611 名个体中（308 名男性[50.4%]；平均[标准差]年龄为 64[6.2]岁），335 名（54.8%）存在至少 1 种肺部相关合并症。与无肺部相关合并症的个体相比，有肺部相关合并症的个体更有可能为女性（335 名中的 180 名[53.7%]比 276 名中的 123 名[44.6%]；P = .02）、白种人比非白种人（326 名中的 275 名[84.4%]比 272 名中的 193 名[71.0%]；P < .001），以及受教育程度低于高中或更高（231 名中的 108 名[46.7%]比 208 名中的 64 名[30.8%]；P = .001）。基线（37 名[16.0%]比 22 名[11.1%]；P = .14）或随后（40 名[12.3%]比 23 名[10.6%]；P = .54）的 LCS 检查中，有肺部相关合并症与无肺部相关合并症的个体中阳性 LCS 检查的比例无显著差异。与无肺部相关合并症的个体相比，有肺部相关合并症的个体的 CDR（每 100 人 1.6 比 1.9；P = .73）或 FPR（每 100 人 13.0 比 9.3；P = .16）无统计学显著差异。在 17 名肺癌患者中，13 名（76.5%）被诊断为 I 期肺癌。
本研究结果表明，与无肺部相关合并症的个体相比，接受 LCS 的自我报告存在肺部相关合并症的个体更有可能为女性、白种人、受教育程度较低。尽管自我报告的肺部合并症在阳性检查比例、CDR 或 FPR 方面没有统计学显著差异，但需要更多接受筛查的个体进行更大规模的研究，以了解肺部相关合并症患者的 LCS 结果。
