Kim Roger Y, Rendle Katharine A, Mitra Nandita, Neslund-Dudas Christine, Greenlee Robert T, Honda Stacey A, Schapira Marilyn M, Simoff Michael J, Jeon Jihyoun, Meza Rafael, Ritzwoller Debra P, Vachani Anil
Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2025 Mar 3;8(3):e250942. doi: 10.1001/jamanetworkopen.2025.0942.
Adherence to annual lung cancer screening (LCS) is a proposed quality metric for LCS programs, but data linking annual adherence to lung cancer outcomes are lacking.
To investigate annual LCS adherence rates across 2 subsequent LCS rounds among adults undergoing baseline LCS and examine the association of adherence with lung cancer diagnosis rates.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults aged 55 to 75 years who formerly or currently smoked and underwent baseline LCS between January 1, 2015, and December 31, 2018, across 5 US health care systems in the Population-Based Research to Optimize the Screening Process-Lung Consortium. Participants with missing Lung Computed Tomography Screening Reporting & Data System scores or a lung cancer diagnosis prior to LCS initiation were excluded. Data were analyzed from October 2023 to October 2024.
For negative baseline screening results, T1 and T2 screening adherence was defined as chest computed tomography (CT) between 10 and 18 months and 22 and 30 months after baseline, respectively. For positive baseline screening results, T1 and T2 adherence was defined as chest CT between 11 and 21 months and 28 and 36 months after baseline, respectively.
The main outcomes were annual T1 and T2 LCS adherence rates and associations between T1 and T2 screening adherence; annual incident lung cancer diagnoses in rounds T0 (0-12 months after baseline), T1 (>12 to 24 months after baseline), and T2 (>24 to 36 months after baseline); and cancer stage distribution.
A total of 10 170 individuals received baseline LCS (median age, 65 years [IQR, 60-69 years]; 5415 [53.2%] male). During round T1, 6141 of 10 033 eligible patients (61.2% [95% CI, 60.2%-62.2%]) were adherent, and during round T2, 5028 of 9966 eligible patients (50.5% [95% CI, 49.5%-51.4%]) were adherent. T1 adherence was significantly associated with T2 adherence (adjusted relative risk, 2.40; 95% CI, 2.06-2.79). Across 36 months of follow-up, 279 patients (2.7%; 95% CI, 2.4%-3.1%) were diagnosed with lung cancer. Incident lung cancer diagnosis rates were 1.3% (95% CI, 1.1%-1.6%), 0.7% (95% CI, 0.5%-0.8%), and 0.8% (95% CI, 0.6%-0.9%) during rounds T0, T1, and T2, respectively. Lung cancer diagnosis rates were higher among individuals who were LCS adherent vs nonadherent during both rounds T1 (59 of 6141 [1.0%; 95% CI, 0.7%-1.2%] vs 8 of 3892 [0.2%; 95% CI, 0.1%-0.4%]; P < .001) and T2 (63 of 5028 [1.3%; 95% CI, 1.0%-1.6%] vs 12 of 4938 [0.2%; 95% CI, 0.1%-0.4%]; P < .001). A greater proportion of early-stage lung cancers were diagnosed among individuals adherent to screening at T2 compared with those who were not (46 of 63 [73.0%] vs 3 of 12 [25.0%]; P = .006).
In this multicenter cohort study of adults undergoing LCS, screening adherence was associated with increased overall and early-stage lung cancer detection rates; however, adherence decreased annually after baseline screening, suggesting that it is an important LCS quality metric.
坚持年度肺癌筛查（LCS）是LCS项目一项提议的质量指标，但缺乏将年度坚持情况与肺癌结局相联系的数据。
调查接受基线LCS的成年人在随后两轮LCS中的年度LCS坚持率，并检验坚持情况与肺癌诊断率之间的关联。
设计、设置和参与者：这项回顾性队列研究纳入了年龄在55至75岁之间、曾经或目前吸烟且在2015年1月1日至2018年12月31日期间在美国5个医疗系统的基于人群的优化筛查流程-肺癌联盟中接受基线LCS的成年人。排除肺计算机断层扫描筛查报告与数据系统评分缺失或在LCS开始前已被诊断为肺癌的参与者。数据于2023年10月至2024年10月进行分析。
对于基线筛查结果为阴性的情况，T1和T2筛查坚持情况分别定义为在基线后10至18个月和22至30个月进行胸部计算机断层扫描（CT）。对于基线筛查结果为阳性的情况，T1和T2坚持情况分别定义为在基线后11至21个月和28至36个月进行胸部CT。
主要结局为年度T1和T2 LCS坚持率以及T1和T2筛查坚持情况之间的关联；在T0轮（基线后0至12个月）、T1轮（基线后>12至24个月）和T2轮（基线后>24至36个月）的年度新发肺癌诊断情况；以及癌症分期分布。
共有10170人接受了基线LCS（中位年龄65岁[四分位间距，60 - 69岁]；5415人[53.2%]为男性）。在T1轮中，10033名符合条件的患者中有6141人（61.2%[95%置信区间，60.2% - 62.2%]）坚持筛查，在T2轮中，9966名符合条件的患者中有5028人（50.5%[95%置信区间，49.5% - 51.4%]）坚持筛查。T1坚持情况与T2坚持情况显著相关（调整后的相对风险，2.40；95%置信区间，2.06 - 2.79）。在36个月的随访期间，279名患者（2.7%；95%置信区间，2.4% - 3.1%）被诊断为肺癌。在T0、T1和T2轮中，新发肺癌诊断率分别为1.3%（95%置信区间，1.1% - 1.6%）、0.7%（95%置信区间，0.5% - 0.8%）和0.8%（95%置信区间，0.6% - 0.9%）。在T1轮和T2轮中，LCS坚持者的肺癌诊断率均高于未坚持者（T1轮：6141人中的59人[1.0%；95%置信区间，0.7% - 1.2%]对比3892人中的8人[0.2%；95%置信区间，0.1% - 0.4%]；P <.001；T2轮：5028人中的63人[1.3%；95%置信区间，1.0% - 1.6%]对比4938人中的12人[0.2%；95%置信区间，0.1% - 0.4%]；P <.001）。与未坚持筛查的人相比，在T2轮坚持筛查的人中诊断出的早期肺癌比例更高（63人中的46人[73.0%]对比12人中的3人[25.0%]；P = 0.006）。
在这项针对接受LCS的成年人的多中心队列研究中，筛查坚持情况与总体及早期肺癌检测率的提高相关；然而，基线筛查后坚持率逐年下降，表明它是一项重要的LCS质量指标。
