美国马萨诸塞州总医院Chi-Fu Jeffrey Yang团队研究了美国计算机断层扫描筛查与肺癌分期转移和生存率的相关性。该研究于2022年3月30日发表在《英国医学杂志》上。

为了确定2013年引入低剂量计算机断层扫描筛查对美国肺癌分期转移、生存率和诊断分期差异的影响，研究组使用联合点建模、多变量有序logistic回归和多变量Cox比例风险建模进行了一项准实验研究。使用美国国家癌症数据库和监测流行病学最终结果项目数据库，2010年1月1日至2018年12月31日，招募45-80岁、被诊断为非小细胞肺癌（NSCLC）的患者。

主要观察指标为45-54岁（不符合筛查条件）和55-80岁（可能符合筛查条件）患者中确诊的I期NSCLC百分比的年变化百分比、中位全因生存率和NSCLC发病率；诊断时疾病早期发生的可能性年与年变化的多变量校正优势比，以及筛查前后死亡风险变化的多变量校正风险比。

从2010到2013年，55-80岁患者中诊断为I期NSCLC的比例没有显著增加（从27.8%增加到29.4%），之后2014到2018年以每年3.9%的速度增加（从30.2%增加到35.5%）。在多变量校正后分析中，2014至2018年间，诊断时肺癌分期较低的患者年化率增加为6.2%（多变量校正后的几率比1.062，差异显著），高于2010至2013年间年化率增加程度。

同样，从2010到2013年，55-80岁患者的全因生存期中位数没有显著增加（从15.8个月到18.1个月），之后2014到2018年以每年11.9%的速度增加（从19.7个月到28.2个月）。在多变量校正分析中，与2014年前相比，2014年后死亡风险的降低速度显著加快。

到2018年，I期NSCLC在非西班牙裔白人和生活在收入最高或受教育程度最高地区的人群中占主导地位。非白人和生活在收入较低或教育程度较低地区的人在诊断时仍更有可能患IV期NSCLC。2014到2018年，美国早期疾病检出率的增加使大约10100例患者避免死亡。

研究结果表明，近期随着生存率的提高和肺癌筛查的引入，NSCLC向I期转移。非白人患者和生活在贫困地区的患者的I期疾病确诊率较低，这突显出美国仍需努力增加筛查的机会。

附：英文原文

Title: Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study

Author: Alexandra L Potter, Allison L Rosenstein, Mathew V Kiang, Shivani A Shah, Henning A Gaissert, David C Chang, Florian J Fintelmann, Chi-Fu Jeffrey Yang

Issue&Volume: 2022/03/30

Abstract:

Objective To determine the effect of the introduction of low dose computed tomography screening in 2013 on lung cancer stage shift, survival, and disparities in the stage of lung cancer diagnosed in the United States.

Design Quasi-experimental study using Joinpoint modeling, multivariable ordinal logistic regression, and multivariable Cox proportional hazards modeling.

Setting US National Cancer Database and Surveillance Epidemiology End Results program database.

Participants Patients aged 45-80 years diagnosed as having non-small cell lung cancer (NSCLC) between 1 January 2010 and 31 December 2018.

Main outcome measures Annual per cent change in percentage of stage I NSCLC diagnosed among patients aged 45-54 (ineligible for screening) and 55-80 (potentially eligible for screening), median all cause survival, and incidence of NSCLC; multivariable adjusted odds ratios for year-to-year changes in likelihood of having earlier stages of disease at diagnosis and multivariable adjusted hazard ratios for changes in hazard of death before versus after introduction of screening.

Results The percentage of stage I NSCLC diagnosed among patients aged 55-80 did not significantly increase from 2010 to 2013 (from 27.8% to 29.4%) and then increased at 3.9% (95% confidence interval 3.0% to 4.8%) per year from 2014 to 2018 (from 30.2% to 35.5%). In multivariable adjusted analysis, the increase in the odds per year of a patient having one lung cancer stage lower at diagnosis during the time period from 2014 to 2018 was 6.2% (multivariable adjusted odds ratio 1.062, 95% confidence interval 1.048 to 1.077; P<0.001) higher than the increase in the odds per year from 2010 to 2013. Similarly, the median all cause survival of patients aged 55-80 did not significantly increase from 2010 to 2013 (from 15.8 to 18.1 months), and then increased at 11.9% (8.9% to 15.0%) per year from 2014 to 2018 (from 19.7 to 28.2 months). In multivariable adjusted analysis, the hazard of death decreased significantly faster after 2014 compared with before 2014 (P<0.001). By 2018, stage I NSCLC was the predominant diagnosis among non-Hispanic white people and people living in the highest income or best educated regions. Non-white people and those living in lower income or less educated regions remained more likely to have stage IV disease at diagnosis. Increases in the detection of early stage disease in the US from 2014 to 2018 led to an estimated 10100 averted deaths.

Conclusions A recent stage shift toward stage I NSCLC coincides with improved survival and the introduction of lung cancer screening. Non-white patients and those living in areas of greater deprivation had lower rates of stage I disease identified, highlighting the need for efforts to increase access to screening in the US.

DOI: 10.1136/bmj-2021-069008

Source: https://www.bmj.com/content/376/bmj-2021-069008