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肺癌CT查的好处和危害:一个系统的审查
Peter B Bach1, Joshua N Mirkin, Thomas K Oliver
1Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
JAMA
|May 22, 2012
概括
低剂量计算机断层扫描 (LDCT) 查可能会降低高风险个体的肺癌死亡率. 然而,潜在的危害和发现的概括性需要进一步调查.
科学领域:
- 在瘤学瘤学.
- 放射学 放射学是一门学科.
- 公共卫生 公共卫生
背景情况:
- 肺癌是癌症死亡的主要原因,大多数病例是在晚期诊断出来的.
- 通过查及早检测对于降低肺癌死亡率至关重要.
- 目前晚期肺癌的存活率仍然非常低.
研究的目的:
- 系统地审查关于低剂量计算机断层扫描 (LDCT) 查肺癌的益处和危害的证据.
- 为制定肺癌查的基于证据的临床指导方针提供信息.
- 综合来自多社会协作倡议的发现.
主要方法:
- 通过MEDLINE,EMBASE和Cochrane图书馆 (1996-2012) 确定的随机试验和队列研究的系统审查.
- 包括8个随机试验和13个评估LDCT查的队列研究.
- 评估的主要结果是肺癌死亡率和全因死亡率;次要结果包括结节检测和与程序相关的危害.
主要成果:
- 国家肺部查试验显示,使用LDCT查,肺癌死亡率显著降低 (RR,0.80;95% CI,0.73-0.93).
- 其他较小的试验没有显示出显著的死亡率益处.
- 大约20%的查结果呈阳性,随着良性疾病的后续程序造成重大并发症的发生率较低.
结论:
- 低剂量计算机断层扫描查显示,对于肺癌风险较高的人来说,有潜在的益处.
- 关于查危害的全部范围和当前证据的概括性,仍然存在不确定性.
- 需要进一步的研究来优化查协议并解决不确定性.
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