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肺がんのCTスクリーニングのメリットと害:体系的なレビュー
Peter B Bach1, Joshua N Mirkin, Thomas K Oliver
1Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
JAMA
|May 22, 2012
まとめ
低用量コンピューティングトモグラフィー (LDCT) スクリーニングは,高リスクの個人に肺がんによる死亡を減らす可能性があります. しかし,潜在的な害と結果の汎用性については,さらなる調査が必要である.
科学分野:
- 腫瘍学 腫瘍学
- 放射線学 放射線学
- 公衆衛生は公衆衛生である.
背景:
- 肺がんはがんによる死亡の主な原因であり,ほとんどの症例は進行段階で診断されます.
- スクリーニングによる早期発見は,肺がんの死亡率を低減するために極めて重要です.
- 進行した肺がんの現在の生存率は非常に低いままです.
研究 の 目的:
- 肺がんの低用量コンピュータ断層撮影 (LDCT) スクリーニングの利点と害に関する証拠を体系的に検討する.
- 肺がんのスクリーニングのためのエビデンスに基づく臨床ガイドラインの開発を図る.
- 多社会共同イニシアチブの成果をまとめること.
主な方法:
- MEDLINE,EMBASE,コクラン図書館 (1996-2012) を通じて特定されたランダム化試験とコホート研究の体系的レビュー.
- LDCTスクリーニングを評価する8つのランダム化試験と13のコホート研究を含む.
- 評価された主なアウトカムには,肺がんによる死亡率と全原因による死亡率が含まれる. 二次的なアウトカムには,結節の検出と処置に関連する害が含まれている.
主要な成果:
- 全国肺部スクリーニング試験は,LDCTスクリーニングで肺がんによる死亡率の有意な減少を示しました (RR, 0.80; 95% CI, 0.73-0.93).
- 他の小規模な試験では,有意な死亡率の利点は示されなかった.
- 約20%のスクリーニングで陽性結果が得られ,良性疾患のフォローアップ手順による重大な合併症の発生率は低い.
結論:
- 低用量コンピュータートモグラフィーのスクリーニングは,肺がんのリスクが高い個人に潜在的な利点を示しています.
- スクリーニングによる害の全スペクトルと,現在の証拠の一般化について,依然として不確実性があります.
- スクリーニングプロトコルを最適化し,不確実性に対処するためにさらなる研究が必要です.
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