Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening

作者: Nanda Horeweg , Joost van Rosmalen , Marjolein A Heuvelmans , Carlijn M van der Aalst , Rozemarijn Vliegenthart

DOI: 10.1016/S1470-2045(14)70389-4

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摘要: Summary Background The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and relatively low incidence cancer. Management protocols use thresholds nodule size growth rate to determine which require additional diagnostic procedures, but these should be based on individuals' probabilities developing In this prespecified analysis, using data from NELSON trial, we aimed quantify how diameter, volume, volume doubling time affect probability within 2 years a scan, propose evaluate management protocols. Methods Eligible participants trial were those aged 50–75 years, who have smoked 15 cigarettes or more per day than 25 ten 30 still smoking, had stopped smoking less 10 ago. Participants randomly assigned low-dose at increasing intervals, no screening. We included all group attended least one round screening, whose results available national registry database. calculated probabilities, stratified by did logistic regression analysis time, multinodularity as potential predictor variables. assessed strategies threshold characteristics specificity sensitivity, compared them American College Chest Physicians (ACCP) guidelines. registered www.trialregister.nl, number ISRCTN63545820. Findings Volume, volumetry-based diameter 9681 non-calcified detected 7155 used probability. Lung was with 100 mm 3 smaller (0·6% [95% CI 0·4–0·8]) maximum transverse 5 (0·4% [0·2–0·7]), not significantly different without [0·3–0·6], p=0·17 p=1·00, respectively). intermediate (requiring follow-up CT) if 100–300 (2·4% 1·7–3·5]) 5–10 (1·3% [1·0–1·8]). Volume further probabilities: 0·8% (95% 0·4–1·7) times 600 days more, 4·0% (1·8–8·3) 400–600 days, 9·9% (6·9–14·1) 400 fewer. volumes 300 bigger (16·9% 14·1–20·0]) diameters (15·2% [12·7–18·1]). simulated ACCP protocol yielded sensitivity 90·9% 81·2–96·1), 87·2% (86·4–87·9), respectively. A diameter-based higher (92·4% 83·1–97·1]), (90·0% [89·3–90·7). volume-based (with probability) same (90·9% 81·2–96·1]), (94·9% [94·4–95·4]). Interpretation Small (those ≥10 mm). assessment advocated only intermediate-sized ranging between Nodule performed better protocol. Funding Zorgonderzoek Nederland Medische Wetenschappen Koningin Wilhelmina Fonds.

参考文章(36)
Anthony P. Reeves, Alberto M. Biancardi, Tatiyana V. Apanasovich, Charles R. Meyer, Heber MacMahon, Edwin J.R. van Beek, Ella A. Kazerooni, David Yankelevitz, Michael F. McNitt-Gray, Geoffrey McLennan, Samuel G. Armato, Claudia I. Henschke, Denise R. Aberle, Barbara Y. Croft, Laurence P. Clarke, The Lung Image Database Consortium (LIDC) Academic Radiology. ,vol. 14, pp. 1475- 1485 ,(2007) , 10.1016/J.ACRA.2007.09.005
, Reduced lung-cancer mortality with low-dose computed tomographic screening. The New England Journal of Medicine. ,vol. 365, pp. 395- 409 ,(2011) , 10.1056/NEJMOA1102873
D.G. Altman, P. Royston, Regression using fractional polynomials of continuous covariates: parsimonious parametric modelling. Insurance Mathematics & Economics. ,vol. 2, pp. 165- 166 ,(1995)
Andrea C. Villanti, Yiding Jiang, David B. Abrams, Bruce S. Pyenson, A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions PLoS ONE. ,vol. 8, pp. e71379- ,(2013) , 10.1371/JOURNAL.PONE.0071379
K A M van den Bergh, M L Essink-Bot, G J J M Borsboom, E Th Scholten, M Prokop, H J de Koning, R J van Klaveren, Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON). British Journal of Cancer. ,vol. 102, pp. 27- 34 ,(2010) , 10.1038/SJ.BJC.6605459
Bethany B. Tan, Kevin R. Flaherty, Ella A. Kazerooni, Mark D. Iannettoni, The solitary pulmonary nodule. Chest. ,vol. 123, pp. 89- ,(2003) , 10.1378/CHEST.123.1_SUPPL.89S
Marie-Pierre Revel, Alvine Bissery, Marie Bienvenu, Laetitia Aycard, Catherine Lefort, Guy Frija, Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? Radiology. ,vol. 231, pp. 453- 458 ,(2004) , 10.1148/RADIOL.2312030167
Renda Soylemez Wiener, Michael K. Gould, Steven Woloshin, Lisa M. Schwartz, Jack A. Clark, What Do You Mean, a Spot? Chest. ,vol. 143, pp. 672- 677 ,(2013) , 10.1378/CHEST.12-1095
Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Stephen J. Swensen, Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society Radiology. ,vol. 237, pp. 395- 400 ,(2005) , 10.1148/RADIOL.2372041887