Liu Yin, Geng Qingchao, Lin Xin, Feng Chenxi, Qiao Youlin, Zhang Shaokai
Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 45008, China.
Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China.
BMC Cancer. 2024 Dec 23;24(1):1567. doi: 10.1186/s12885-024-13356-6.
It has been proposed that risk model-based strategies could serve as viable alternatives to traditional risk factor-based approaches in lung cancer screening; however, there has been no systematic discussion. In this review, we provide an overview of the benefits, harms, and cost-effectiveness of these two strategies in lung cancer screening application, as well as discussing possible future research directions.
Following the PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Cochrane libraries, and EMBASE from January 1994 to April 2024. Studies comparing risk model-based and risk factor-based low-dose computed tomography(LDCT) screening strategies for lung cancer were included, with data extracted on study characteristics, screening criteria, and outcomes such as sensitivity, specificity, lung cancer deaths averted, false positive, biopsies, overdiagnosis, radiation-related cancer, and cost-effectiveness measures, et al. RESULTS: A total of 16 fulfilled articles were included, comprising 6 model simulation studies, 9 retrospective cohort studies, and 1 interim analysis of a prospective cohort study. Risk model-based strategies generally demonstrated higher sensitivity, comparable specificity and lower radiation-related harms compared to risk factor-based strategies. However, there were variations in life years gained, quality-adjusted life years gained, lung cancer deaths averted and overdiagnosis cases, highlighting the need for optimal risk threshold determination. Risk model-based strategies showed a potential for greater cost-effectiveness, particularly when tailored to individual risk profiles. Furthermore, subgroup analyses revealed a higher net benefit in women, emphasizing the importance of sex-specific eligibility criteria.
Risk model-based LDCT screening strategies present a more sensitive and potentially more efficient approach for lung cancer detection. Future research should explore optimal risk thresholds for broader applicability, with attention to sex-specific criteria and individual risk factor dynamics.
有人提出，基于风险模型的策略可作为肺癌筛查中传统基于风险因素方法的可行替代方案；然而，尚未有系统的讨论。在本综述中，我们概述了这两种策略在肺癌筛查应用中的益处、危害和成本效益，并讨论了未来可能的研究方向。
遵循PRISMA指南，于1994年1月至2024年4月在PubMed、科学网、Cochrane图书馆和EMBASE上进行了全面的文献检索。纳入了比较基于风险模型和基于风险因素的低剂量计算机断层扫描（LDCT）肺癌筛查策略的研究，并提取了关于研究特征、筛查标准以及敏感性、特异性、避免的肺癌死亡、假阳性、活检、过度诊断、辐射相关癌症和成本效益措施等结果的数据。
共纳入16篇符合要求的文章，包括6篇模型模拟研究、9篇回顾性队列研究和1篇前瞻性队列研究的中期分析。与基于风险因素的策略相比基于风险模型的策略通常表现出更高的敏感性、相当的特异性和更低的辐射相关危害。然而，在获得的生命年、质量调整生命年、避免的肺癌死亡和过度诊断病例方面存在差异，这突出了确定最佳风险阈值的必要性。基于风险模型的策略显示出更大的成本效益潜力，特别是在根据个体风险概况进行调整时。此外，亚组分析显示女性的净效益更高，强调了针对性别的资格标准的重要性。
基于风险模型的LDCT筛查策略为肺癌检测提供了一种更敏感且可能更有效的方法。未来的研究应探索更广泛适用性的最佳风险阈值，同时关注针对性别的标准和个体风险因素动态。
