Eliana E Kim, Irena Cenzer, Francis J Graham, Jasmine Kang, Sei J Lee, Alison S Rustagi
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引用次数: 0
Abstract
Introduction: Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality in the long term but carries immediate risks. Guidelines recommend screening persons whose life expectancy exceeds the screening test's time to benefit (TTB), defined as the time from screening initiation to first observed benefit. This study aimed to estimate the TTB for lung cancer screening to prevent lung cancer mortality.
Methods: Randomized controlled trials of lung cancer screening with LDCT were identified from two prior systematic reviews and an updated search to December 3, 2023. Studies that reported lung cancer mortality were included. For each study, independent Weibull survival curves were fitted and Markov chain Monte Carlo simulations were generated to estimate the absolute risk reduction at different time points. Time to benefit was determined as the time at which absolute risk reduction thresholds (ARR=0.0005, 0.001, 0.002) were crossed. These estimates were pooled using a random-effects meta-analysis model.
Results: A total of eight randomized controlled trials comprising 88,526 participants were included. Enrollment age ranged from 50 to 70 years of age; follow-up duration ranged from 7.3 to 12.3 years. For every 1000 persons screened, 3.4 years (95% CI 2.2-5.1) passed before one death from lung cancer was prevented (ARR=0.001). The time to prevent one lung cancer death per 2000 persons screened (ARR=0.0005) was 2.2 years (95% CI 1.4-3.4); per 500 persons screened (ARR=0.002), it was 5.2 years (95% CI 3.7-7.3).
Discussion: Lung cancer screening is most appropriate for older adults at high risk of lung cancer with a life expectancy greater than 3.4 years.
肺癌筛查低剂量计算机断层扫描（LDCT）在长期内降低肺癌死亡率，但具有直接风险。指南建议对预期寿命超过筛查试验获益时间（TTB）的人进行筛查，TTB定义为从筛查开始到首次观察到获益的时间。本研究旨在评估TTB对肺癌筛查预防肺癌死亡率的影响。方法：LDCT筛查肺癌的随机对照试验从先前的两项系统评价和截至2023年12月3日的最新检索中确定。报告肺癌死亡率的研究也包括在内。对于每项研究，拟合独立的威布尔生存曲线，并生成马尔可夫链蒙特卡罗模拟，以估计不同时间点的绝对风险降低。获益时间确定为超过绝对风险降低阈值（ARR=0.0005, 0.001, 0.002）的时间。这些估计使用随机效应荟萃分析模型进行汇总。结果：共纳入8项随机对照试验，共纳入88,526名受试者。入组年龄50 ~ 70岁；随访时间为7.3 - 12.3年。每1000名筛查者中，3.4年（95% CI 2.2-5.1）后，1例肺癌死亡得以预防（ARR=0.001）。每2000名筛查者预防1例肺癌死亡的时间（ARR=0.0005）为2.2年（95% CI 1.4-3.4）；每500名筛查者（ARR=0.002），为5.2年（95% CI 3.7-7.3）。讨论：肺癌筛查最适用于预期寿命大于3.4年的肺癌高危老年人。
期刊介绍：
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.
Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.
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