http://www.nejm.org/doi/full/10.1056/NEJMoa1209120
BACKGROUND
Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer–screening programs.
肺癌目前是癌症死亡人口最多的癌症之一, NLST 研究比較使用 低劑量螺旋電腦斷層篩檢 與傳統胸部X光相比, 可有效降低肺癌死亡率, 本研究進一步報告其成果
METHODS
At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination.
在全美國33家醫學中心, 自2002年8月到2004年4月, 研究納入55至74歲 在過去有抽煙習慣(1年抽約30包煙) 的成年人,比較使用低劑量螺旋電腦斷層篩檢 與傳統胸部X光相比, 篩檢三年, 比較篩檢差異
RESULTS
A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively.
在約50000人中, 兩組人數大約相等, 在研究期間, 低劑量螺旋電腦斷層組約可發現27.3%異常結果, 相較胸部X光只有9.2%, 之後所造成診斷肺癌人數比例也有明顯差異 (1.1% vs 0.7%), 低劑量螺旋電腦斷層對於篩檢肺癌的敏感性及特異性為93.8%及73.4%, 胸部X光片則為73.5%以及91.3%.
CONCLUSIONS
The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.)
本NLST研究初步報告發現 利用低劑量螺旋電腦斷層, 在電腦斷層篩檢經驗豐富的醫學中心, 對於患有肺癌的高危險族群(吸煙者), 可以有效地降低肺癌癌症死亡率
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