Satoh Shina, Shah Manav, Sungelo Mitchell, Falzon Louise, Makhnevich Alex, Bade Brett, Cohn Elizabeth, Raoof Suhail, Chusid Jesse, Lesser Martin, Davidson Karina, Silvestri Gerard A, Cohen Stuart L
Northwell Health, 2000 Marcus Ave., Suite 300, New Hyde Park, NY, 11042-1069, USA.
Department of Radiology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.
J Gen Intern Med. 2025 May;40(6):1288-1296. doi: 10.1007/s11606-024-09097-8. Epub 2024 Nov 13.
Few eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT).
What is the efficacy of interventions to increase LCS participation?
We performed a systematic review following a prespecified protocol registered in PROSPERO (CRD42021283984). In June/July of 2021, we searched Ovid MEDLINE, Embase, Cochrane, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Epistemonikos from 1946 to October 2021 to identify studies evaluating interventions to increase LCS participation.
Thirteen of 2761 studies met inclusion criteria for data extraction. Of these, six had results available (five RCTs and one prospective observational study). The studies had predominantly White and non-Hispanic participants.
An intention-to-treat analysis was used to calculate each study's relative risk (RR) to increase LCS. Effect sizes were pooled using a random-effects model with a subgroup analysis for multi- versus single-step interventions. Risk of bias was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I).
Overall, the proportion of screening LDCTs performed did not improve in the intervention group relative to the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I = 91%). Subgroup analysis suggests that interventions targeting multiple barriers may increase LCS participation (RR [95% CI] for multistep vs single-step; 2.68 [1.77, 4.05] vs 0.99 [0.89, 1.10], P < 0.01). Quality assessment revealed that three of five RCTs showed some concerns or high risk of bias.
Evidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit.
在美国，很少有符合条件的患者参与低剂量计算机断层扫描（LDCT）肺癌筛查（LCS）。
增加LCS参与度的干预措施的效果如何？
我们按照在PROSPERO（CRD42021283984）注册的预先指定方案进行了系统评价。2021年6月/7月，我们检索了1946年至2021年10月期间的Ovid MEDLINE、Embase、Cochrane、CENTRAL、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台和Epistemonikos，以确定评估增加LCS参与度干预措施的研究。
2761项研究中有13项符合数据提取的纳入标准。其中，6项有可用结果（5项随机对照试验和1项前瞻性观察性研究）。这些研究的参与者主要是白人和非西班牙裔。
采用意向性分析计算每项研究增加LCS的相对风险（RR）。使用随机效应模型合并效应量，并对多步骤与单步骤干预进行亚组分析。使用修订的Cochrane偏倚风险工具（RoB 2）和干预非随机研究中的偏倚风险（ROBINS-I）评估偏倚风险。
总体而言，干预组相对于对照组进行筛查LDCT的比例没有提高（RR [95%CI]为1.30 [0.74, 2.29]），荟萃分析表明研究存在高度异质性（I = 91%）。亚组分析表明，针对多个障碍的干预措施可能会增加LCS参与度（多步骤与单步骤的RR [95%CI]；2.68 [1.77, 4.05]对0.99 [0.89, 1.10]，P < 0.01）。质量评估显示，5项随机对照试验中有3项存在一些担忧或高偏倚风险。
由于在具有关键偏倚风险的非多样化人群中进行的前瞻性研究数量较少，关于增加LCS参与度干预措施效果的证据有限。此外，总体而言，所研究的干预措施并未提高肺癌筛查参与度，尽管针对多个障碍的干预措施可能有一些益处。
