Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
School of Public Health, University of Memphis, Memphis, Tennessee.
JAMA Netw Open. 2023 Feb 1;6(2):e230787. doi: 10.1001/jamanetworkopen.2023.0787.
Guideline-concordant management of lung nodules promotes early lung cancer diagnosis, but the lung cancer risk profile of persons with incidentally detected lung nodules differs from that of screening-eligible persons.
To compare lung cancer diagnosis hazard between participants receiving low-dose computed tomography screening (LDCT cohort) and those in a lung nodule program (LNP cohort).
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included LDCT vs LNP enrollees from January 1, 2015, to December 31, 2021, who were seen in a community health care system. Participants were prospectively identified, data were abstracted from clinical records, and survival was updated at 6-month intervals. The LDCT cohort was stratified by Lung CT Screening Reporting and Data System as having no potentially malignant lesions (Lung-RADS 1-2 cohort) vs those with potentially malignant lesions (Lung-RADS 3-4 cohort), and the LNP cohort was stratified by smoking history into screening-eligible vs screening-ineligible groups. Participants with prior lung cancer, younger than 50 years or older than 80 years, and lacking a baseline Lung-RADS score (LDCT cohort only) were excluded. Participants were followed up to January 1, 2022.
Comparative cumulative rates of lung cancer diagnosis and patient, nodule, and lung cancer characteristics between programs, using LDCT as a reference.
There were 6684 participants in the LDCT cohort (mean [SD] age, 65.05 [6.11] years; 3375 men [50.49%]; 5774 [86.39%] in the Lung-RADS 1-2 and 910 [13.61%] in the Lung-RADS 3-4 cohorts) and 12 645 in the LNP cohort (mean [SD] age, 65.42 [8.33] years; 6856 women [54.22%]; 2497 [19.75%] screening eligible and 10 148 [80.25%] screening ineligible). Black participants constituted 1244 (18.61%) of the LDCT cohort, 492 (19.70%) of the screening-eligible LNP cohort, and 2914 (28.72%) of the screening-ineligible LNP cohort (P < .001). The median lesion size was 4 (IQR, 2-6) mm for the LDCT cohort (3 [IQR, 2-4] mm for Lung-RADS 1-2 and 9 [IQR, 6-15] mm for Lung-RADS 3-4 cohorts), 9 (IQR, 6-16) mm for the screening-eligible LNP cohort, and 7 (IQR, 5-11) mm for the screening-ineligible LNP cohort. In the LDCT cohort, lung cancer was diagnosed in 80 participants (1.44%) in the Lung-RADS 1-2 cohort and 162 (17.80%) in the Lung-RADS 3-4 cohort; in the LNP cohort, it was diagnosed in 531 (21.27%) in the screening-eligible cohort and 447 (4.40%) in the screening-ineligible cohort. Compared with Lung-RADS 1-2, the fully adjusted hazard ratios (aHRs) were 16.2 (95% CI, 12.7-20.6) for the screening-eligible cohort and 3.8 (95% CI, 3.0-5.0) for the screening-ineligible cohort; compared with Lung-RADS 3-4, the aHRs were 1.2 (95% CI, 1.0-1.5) and 0.3 (95% CI, 0.2-0.4), respectively. The stage of lung cancer was I to II in 156 of 242 patients (64.46%) in the LDCT cohort, 276 of 531 (52.00%) in the screening-eligible LNP cohort, and 253 of 447 (56.60%) in the screening-ineligible LNP cohort.
In this cohort study, the cumulative lung cancer diagnosis hazard of screening-age persons enrolled in the LNP was higher than that in a screening cohort, irrespective of smoking history. The LNP provided access to early detection for a higher proportion of Black persons.
肺结节的指南一致管理促进了早期肺癌的诊断，但偶然发现肺结节的个体的肺癌风险状况与筛查合格者不同。
比较低剂量计算机断层扫描筛查（LDCT 队列）和肺结节计划（LNP 队列）参与者的肺癌诊断危险。
设计、设置和参与者：这项前瞻性队列研究包括 2015 年 1 月 1 日至 2021 年 12 月 31 日在社区医疗系统中就诊的 LDCT 与 LNP 入组者。前瞻性地确定参与者，从临床记录中提取数据，并每隔 6 个月更新生存情况。LDCT 队列根据肺 CT 筛查报告和数据系统分为无潜在恶性病变（Lung-RADS 1-2 队列）和有潜在恶性病变（Lung-RADS 3-4 队列），LNP 队列根据吸烟史分为筛查合格和筛查不合格组。排除了有既往肺癌、年龄小于 50 岁或大于 80 岁且缺乏基线 Lung-RADS 评分（仅 LDCT 队列）的参与者。参与者随访至 2022 年 1 月 1 日。
使用 LDCT 作为参考，比较计划之间的累积肺癌诊断率和患者、结节和肺癌特征。
LDCT 队列有 6684 名参与者（平均[标准差]年龄 65.05[6.11]岁；3375 名男性[50.49%]；5774 名[86.39%]在 Lung-RADS 1-2 队列和 910 名[13.61%]在 Lung-RADS 3-4 队列），LNP 队列有 12645 名参与者（平均[标准差]年龄 65.42[8.33]岁；6856 名女性[54.22%]；2497 名[19.75%]筛查合格，10148 名[80.25%]筛查不合格）。黑人参与者在 LDCT 队列中占 1244 人（18.61%），在筛查合格的 LNP 队列中占 492 人（19.70%），在筛查不合格的 LNP 队列中占 2914 人（28.72%）（P<0.001）。LDCT 队列的中位病变大小为 4（IQR，2-6）mm（Lung-RADS 1-2 队列中为 3[IQR，2-4]mm，Lung-RADS 3-4 队列中为 9[IQR，6-15]mm），筛查合格的 LNP 队列中为 9（IQR，6-16）mm，筛查不合格的 LNP 队列中为 7（IQR，5-11）mm。在 LDCT 队列中，Lung-RADS 1-2 队列中有 80 名参与者（1.44%）被诊断为肺癌，Lung-RADS 3-4 队列中有 162 名（17.80%）被诊断为肺癌；在 LNP 队列中，在筛查合格的队列中有 531 名（21.27%）被诊断为肺癌，在筛查不合格的队列中有 447 名（4.40%）被诊断为肺癌。与 Lung-RADS 1-2 相比，完全调整的危险比（aHR）分别为 16.2（95%CI，12.7-20.6）和 3.8（95%CI，3.0-5.0）；与 Lung-RADS 3-4 相比，aHR 分别为 1.2（95%CI，1.0-1.5）和 0.3（95%CI，0.2-0.4）。在 LDCT 队列中，242 名患者中有 156 名（64.46%）为肺癌 I 期至 II 期，531 名患者中有 276 名（52.00%）为筛查合格的 LNP 队列，447 名患者中有 253 名（56.60%）为筛查不合格的 LNP 队列。
在这项队列研究中，LNP 入组的筛查年龄人群的累积肺癌诊断危险高于筛查队列，无论吸烟史如何。LNP 为更多的黑人提供了早期检测的机会。
