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首页> 外文期刊>Thorax: The Journal of the British Thoracic Society >CT screening for lung cancer brings forward early disease. The randomised Danish lung cancer screening trial: Status after five annual screening rounds with low-dose CT
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CT screening for lung cancer brings forward early disease. The randomised Danish lung cancer screening trial: Status after five annual screening rounds with low-dose CT

机译：肺癌的CT筛查可带来早期疾病。丹麦随机肺癌筛查试验：低剂量CT进行的五次年度筛查之后的状态

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Background: The effects of low-dose CT screening on disease stage shift, mortality and overdiagnosis are unclear. Lung cancer findings and mortality rates are reported at the end of screening in the Danish Lung Cancer Screening Trial. Methods: 4104 men and women, healthy heavy smokers/former smokers were randomised to five annual low-dose CT screenings or no screening. Two experienced chest radiologists read all CT scans and registered the location, size and morphology of nodules. Nodules between 5 and 15 mm without benign characteristics were rescanned after 3 months. Growing nodules (>25% volume increase and/or volume doubling time<400 days) and nodules >15 mm were referred for diagnostic workup. In the control group, lung cancers were diagnosed and treated outside the study by the usual clinical practice. Results: Participation rates were high in both groups (screening: 95.5%; control: 93.0%; p<0.001). Lung cancer detection rate was 0.83% at baseline and mean annual detection rate was 0.67% at incidence rounds (p=0.535). More lung cancers were diagnosed in the screening group (69 vs 24, p<0.001), and more were low stage (48 vs 21 stage I-IIB non-small cell lung cancer (NSCLC) and limited stage small cell lung cancer (SCLC), p=0.002), whereas frequencies of high-stage lung cancer were the same (21 vs 16 stage IIIA-IV NSCLC and extensive stage SCLC, p=0.509). At the end of screening, 61 patients died in the screening group and 42 in the control group (p=0.059). 15 and 11 died of lung cancer, respectively (p=0.428). Conclusion: CT screening for lung cancer brings forward early disease, and at this point no stage shift or reduction in mortality was observed. More lung cancers were diagnosed in the screening group, indicating some degree of overdiagnosis and need for longer follow-up.
机译：背景：低剂量CT筛查对疾病分期，死亡率和过度诊断的影响尚不清楚。丹麦肺癌筛查试验在筛查结束时报告了肺癌的发现和死亡率。方法：将4104名男性，女性，健康的重度吸烟者/前吸烟者随机分为5次年度低剂量CT筛查或不筛查。两名经验丰富的胸部放射科医生阅读了所有CT扫描，并记录了结节的位置，大小和形态。 3个月后重新扫描5至15毫米的无良性结节。结节不断增长的结节（> 25％的体积增加和/或体积加倍的时间<400天）和结​​节> 15 mm进行诊断检查。在对照组中，肺癌是根据常规临床实践在研究之外进行诊断和治疗的。结果：两组的参与率均很高（筛查：95.5％;对照组：93.0％; p <0.001）。基线时肺癌检出率为0.83％，发病率平均年检出率为0.67％（p = 0.535）。在筛查组中诊断出更多的肺癌（69 vs 24，p <0.001），低阶段的更多（48 vs 21阶段的I-IIB非小细胞肺癌（NSCLC）和有限期小细胞肺癌（SCLC） ），p = 0.002），而晚期肺癌的发生频率是相同的（21 vs III期16期IIIA-IV NSCLC和SCLC广泛期，p = 0.509）。筛选结束时，筛选组死亡61例，对照组死亡42例（p = 0.059）。分别有15和11人死于肺癌（p = 0.428）。结论：CT筛查肺癌可带来早期疾病，并且此时未观察到阶段转移或死亡率降低。筛查组诊断出更多的肺癌，表明某种程度的过度诊断，需要更长的随访时间。

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