Eric J Burks, Travis B Sullivan, Kimberly M Rieger-Christ
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引用次数: 0
摘要
背景：全国肺筛查试验（NLST）表明，与胸部 X 光（CXR）筛查相比，低剂量 CT（LDCT）筛查可降低肺癌死亡率。支气管肺泡癌（BAC）的过度诊断率很高（79%），目前已被原位腺癌（AIS）、微小浸润性腺癌（MIA）和低恶性潜能腺癌（LMP）取代，疾病特异性生存率（DSS）达到 100%：比较NLST筛查出的具有过度诊断率的IA期NSCLC中BAC、AIS、MIA和LMP的结果和比例：胸部病理学家对 409 例 NLST 筛选出的 IA 期 LUAD 中的 174 例进行了全切片图像审查。根据随访癌症发病率计算过度诊断率：大多数 BAC 被重新分类为 AIS/MIA/LMP（20/35 = 57%）。AIS/MIA/LMP的7年DSS为100%，BAC为94%。排除AIS/MIA/LMP，BAC的表现与NSCLC相似（7年DSS：86% vs. 83%，p= 0.85）。LDCTⅠA期NSCLC在11.3年的过度诊断率为16.6%，与AIS/MIA/LMP的比例（16.2%）一致，但与AIS/MIA（3.5%）或BAC（22.8%）不一致：结论：AIS/MIA/LMP与NLST中IA期NSCLC的过度诊断率成正比，显示出100%的7年DSS。旨在术前识别AIS/MIA/LMP的生物标记物将有助于防止对筛查出的轻度癌症进行过度治疗。
Pulmonary adenocarcinoma of low malignant potential defines indolent NSCLC associated with overdiagnosis in the national lung screening trial.
Background: The national lung screening trial (NLST) demonstrated a reduction in lung cancer mortality with lowdose CT (LDCT) compared to chest x-ray (CXR) screening. Overdiagnosis was high (79%) among bronchoalveolar carcinoma (BAC) currently replaced by adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and adenocarcinoma of low malignant potential (LMP) exhibiting 100% disease specific survival (DSS).
Objective: Compare the outcomes and proportions of BAC, AIS, MIA, and LMP among NLST screendetected stage IA NSCLC with overdiagnosis rate.
Methods: Whole slide images were reviewed by a thoracic pathologist from 174 of 409 NLST screen-detected stage IA LUAD. Overdiagnosis rates were calculated from follow-up cancer incidence rates.
Results: Most BAC were reclassified as AIS/MIA/LMP (20/35 = 57%). The 7-year DSS was 100% for AIS/MIA/LMP and 94% for BAC. Excluding AIS/MIA/LMP, BAC behaved similarly to NSCLC (7-year DSS: 86% vs. 83%, p= 0.85) The overdiagnosis rate of LDCT stage IA NSCLC was 16.6% at 11.3-years, matching the proportion of AIS/MIA/LMP (16.2%) but not AIS/MIA (3.5%) or BAC (22.8%).
Conclusions: AIS/MIA/LMP proportionally matches the overdiagnosis rate among stage IA NSCLC in the NLST, exhibiting 100% 7-year DSS. Biomarkers designed to recognize AIS/MIA/LMP preoperatively, would be useful to prevent overtreatment of indolent screen-detected cancers.
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