Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Healthcare Big Data Research Institute, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
JAMA Netw Open. 2023 Dec 1;6(12):e2347176. doi: 10.1001/jamanetworkopen.2023.47176.
Despite the recommendations of lung cancer screening guidelines and the evidence supporting the effectiveness of population-based lung screening, a common barrier to effective lung cancer screening is that the participation rates of low-dose computed tomography (LDCT) screening among individuals with the highest risk are not large. There are limited data from clinical practice regarding whether opportunistic LDCT screening is associated with reduced lung-cancer mortality.
To evaluate whether opportunistic LDCT screening is associated with improved prognosis among adults with lung cancer in mainland China.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients diagnosed with lung cancer at Weihai Municipal Hospital Healthcare Group, Weihai City, China, from 2016 to 2021. Data were analyzed from January 2022 to February 2023.
Data collected included demographic indicators, tumor characteristics, comorbidities, blood indexes, and treatment information. Patients were classified into screened and nonscreened groups on the basis of whether or not their lung cancer diagnosis occurred through opportunistic screening.
Follow-up outcome indicators included lung cancer-specific mortality and all-cause mortality. Propensity score matching (PSM) was adopted to account for potential imbalanced factors between groups. The associations between LDCT screening and outcomes were analyzed using Cox regression models based on the matched data. Propensity score regression adjustment and inverse probability treatment weighting were used for sensitivity analysis.
A total of 5234 patients (mean [SD] baseline age, 61.8 [9.8] years; 2518 [48.1%] female) with complete opportunistic screening information were included in the analytical sample, with 2251 patients (42.91%) receiving their lung cancer diagnosis through opportunistic screening. After 1:1 PSM, 2788 patients (1394 in each group) were finally included. The baseline characteristics of the matched patients were balanced between groups. Opportunistic screening with LDCT was associated with a 49% lower risk of lung cancer death (HR, 0.51; 95% CI, 0.42-0.62) and 46% lower risk of all-cause death (HR, 0.54; 95% CI, 0.45-0.64).
In this cohort study of patients with lung cancer, opportunistic lung cancer screening with LDCT was associated with lower lung cancer mortality and all-cause mortality. These findings suggest that opportunistic screening is an important supplement to population screening to improve prognosis of adults with lung cancer.
尽管肺癌筛查指南有建议，且人群为基础的肺癌筛查的有效性有证据支持，但有效肺癌筛查的一个常见障碍是，高危人群中接受低剂量计算机断层扫描（LDCT）筛查的比例不大。关于机会性 LDCT 筛查是否与降低肺癌死亡率相关，临床实践中数据有限。
评估机会性 LDCT 筛查是否与中国大陆肺癌患者的预后改善相关。
设计、地点和参与者：本队列研究纳入了 2016 年至 2021 年期间在中国威海市立医院医疗集团诊断为肺癌的患者。数据分析于 2022 年 1 月至 2023 年 2 月进行。
收集的数据包括人口统计学指标、肿瘤特征、合并症、血液指标和治疗信息。根据肺癌诊断是否通过机会性筛查，将患者分为筛查组和非筛查组。
随访结局指标包括肺癌特异性死亡率和全因死亡率。采用倾向评分匹配（PSM）来考虑组间潜在的不平衡因素。基于匹配数据，采用 Cox 回归模型分析 LDCT 筛查与结局之间的关系。采用倾向评分回归调整和逆概率处理加权法进行敏感性分析。
共纳入 5234 例（平均[标准差]基线年龄，61.8[9.8]岁；2518 例[48.1%]为女性）有完整机会性筛查信息的患者，其中 2251 例（42.91%）通过机会性筛查诊断为肺癌。经过 1:1 PSM 后，最终纳入 2788 例患者（每组 1394 例）。匹配患者的基线特征在组间均衡。机会性 LDCT 筛查与肺癌死亡风险降低 49%相关（HR，0.51；95%CI，0.42-0.62），与全因死亡风险降低 46%相关（HR，0.54；95%CI，0.45-0.64）。
在这项对肺癌患者的队列研究中，机会性 LDCT 肺癌筛查与较低的肺癌死亡率和全因死亡率相关。这些发现表明，机会性筛查是人群筛查的重要补充，可改善肺癌成人患者的预后。
