低剂量CT筛查对人群肺癌死亡率及全因死亡率影响的Meta分析

doi:10.19983/j.issn.2096-8493.2024027

摘要/Abstract

摘要：

目的：系统评价低剂量计算机断层扫描(low-dose computed tomography screening,LDCT)在筛查人群中降低肺癌死亡率和全因死亡率的有效性。方法：计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据知识服务平台等数据库公开发表、国内外有关LDCT筛查肺癌的前瞻性研究,检索时间为2000年1月至2023年8月。对符合纳入标准的研究进行数据提取及质量评价,主要结局指标为肺癌死亡率,次要结局指标为全因死亡率、预防1例患者因肺癌死亡或全因死亡需筛查人数。使用R 4.3.1软件进行Meta分析。结果：共纳入9项前瞻性研究,涵盖了123880名被筛查者,年龄范围为40~75岁,各项研究的中位随访时间在3.6~13.0年。Meta分析结果显示,相比于非LDCT筛查组,LDCT筛查降低了人群16%的肺癌死亡率(RR=0.84,95%CI:0.78~0.91,P<0.001);全因死亡率降低情况差异无统计学意义(RR=0.93,95%CI:0.84~1.03,P=0.151)。亚组分析表明,非LDCT筛查组(对照组)具体亚类与肺癌死亡率降低情况相关。Meta回归结果表明,中位随访时间与全因死亡率降低情况相关。若通过LDCT筛查预防1例患者因肺癌死亡,在非影像学预防/全人群中预计需筛查人数为139名;预防1例患者全因死亡预计需筛查人数为81名。结论：使用LDCT进行肺癌筛查能明显降低40~75岁人群的肺癌死亡率,对特定年龄和风险群体进行LDCT筛查具有重要的公共卫生意义。

关键词: 肺肿瘤, 体层摄影扫描仪,X线计算机, 诊断检查服务, 死亡率, Meta分析(主题)

Abstract:

Objective: To systematically evaluate the effectiveness of low-dose computed tomography screening (LDCT) in reducing lung cancer-specific mortality and all-cause mortality among screened populations. Methods: A comprehensive search was conducted in databases such as PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform for prospective studies on LDCT lung cancer screening, published domestically and internationally from January 2000 to August 2023. Data extraction and quality assessment were performed on studies meeting the inclusion criteria. The primary outcome was lung cancer-specific mortality, while secondary outcomes included all-cause mortality and the number need to be screened (NNBS) to prevent one lung cancer death or death from all causes. Meta-analysis was conducted using R software version 4.3.1. Results: Nine studies with a prospective design were included, covering 123880 individuals screened, aged 40-75 years. The median follow-up time of the studies ranged from 3.6 to 13.0 years. Meta-analysis results showed that compared to non-LDCT screening groups, LDCT screening reduced lung cancer-specific mortality by 16% (RR=0.84, 95%CI: 0.78-0.91, P<0.001). There was no significant difference in the all-cause mortality (RR=0.93, 95%CI: 0.84-1.03, P=0.151). Subgroup analysis indicated that the specific subcategories of the non-LDCT screening group (control group) were related to the reduction in lung cancer mortality. Meta-regression results showed that the median follow-up time was related to the reduction in all-cause mortality. To prevent one death caused by lung cancer through LDCT screening, 139 people were estimated to be screened in the non-imaging prevention/general population; to prevent one death caused by all-cause, 81 people were estimated to be screened. Conclusion: LDCT screening significantly reduces lung cancer-specific mortality in the 40-75 age group, underlining its important public health significance for specific age groups and risk populations.

Key words: Lung neoplasms, Tomography scanners, X-ray computed, Diagnostic services, Mortality, Meta-analysis as topic

中图分类号:

R734.2

字晓慧, 吴芃, 郑苏菲, 孙楠, 赫捷. 低剂量CT筛查对人群肺癌死亡率及全因死亡率影响的Meta分析[J]. 结核与肺部疾病杂志, 2024, 5(2): 106-112. doi: 10.19983/j.issn.2096-8493.2024027

Zi Xiaohui, Wu Peng, Zheng Sufei, Sun Nan, He Jie. Meta-analysis of the impact of low-dose CT screening on population lung cancer-specific mortality and all-cause mortality[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(2): 106-112. doi: 10.19983/j.issn.2096-8493.2024027

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作者	发表年份	国家	筛查时间	非LDCT筛查组类别	筛查年龄范围(岁)	纳入人数 (名)	筛查人数 (名)	筛查女性构成比(%)	筛查轮数(次)	中位随访时间(年)
Infante等^[12]	2015	意大利	2001—2012年	胸部X线摄片等	60~74	2450	1264	0.0	5	8.4
Wille等^[13]	2016	丹麦	2004—2008年	非影像学预防^a	50~70	4104	2052	44.8	5	10.0
Paci等^[14]	2017	意大利	2004—2014年	非影像学预防	55~69	3206	1613	35.1	4	9.3
Doroudi等^[15]	2018	美国	2000—2001年	胸部X线摄片	55~74	3318	1660	22.7	2	5.2
Pastorino等^[16]	2019	意大利	2005—2018年	非影像学预防	49~75	4099	2376	31.6	3	10.0
National Lung Screening Trial Research Team^[17]	2019	美国	2002—2007年	胸部X线摄片	55~74	53454	26722	41.0	3	6.5
Becker等^[18]	2020	德国	2011—2018年	非影像学预防	50~59	4052	2029	35.3	5	8.9
de Koning等^[19]	2020	荷兰	2003—2015年	非影像学预防	50~74	13195	6583	16.4	4	10.0
Li等^[20]	2022	中国	2013—2018年	非影像学预防	40~74	223302	79581	43.7	1	3.6

亚组	纳入研究(项)	肺癌死亡率			全因死亡率
亚组	纳入研究(项)	RR(95%CI)值	异质性检验 (Tau²)	组间差异 (P值)	RR(95%CI)值	异质性检验 (Tau²)	组间差异 (P值)
非LDCT筛查组				0.016			0.175
胸部X线摄片	3	0.91(0.82~1.01)	0		0.97(0.94~1.01)	0
非影像学预防	6	0.74(0.65~0.85)	0		0.88(0.77~1.01)	0.019
随访时间(年)				0.250			0.822
<6	2	0.89(0.50~1.57)	0.127		0.90(0.51~1.57)	0.149
6~9	4	0.89(0.80~0.99)	0		0.97(0.94~1.00)	0
>9	3	0.76(0.65~0.89)	0		0.94(0.83~1.05)	0.006
区域				0.239			0.001
欧洲	6	0.79(0.68~0.90)	0		0.96(0.89~1.03)	0.001
北美洲	2	0.95(0.73~1.23)	0.019		1.04(0.86~1.27)	0.015
国内	1	0.69(0.52~0.91)	-		0.68(0.86~1.27)	-
女性构成比(%)				0.362			0.790
≥40	3	0.85(0.71~1.01)	0.011		0.88(0.69~1.11)	0.038
<40	5	0.76(0.65~0.89)	0		0.96(0.85~1.09)	0.009
0	1	0.99(0.69~1.44)	-		0.95(0.77~1.17)	-

分组	非LDCT筛查人群					SRR	LDCT筛查人群		ARR	NNBS (名)
分组	肺癌死亡 (例)	全因死亡 (例)	总人数 (名)	肺癌死亡率(%)	全因死亡率(%)	SRR	预计肺癌死亡率(%)	预计全因死亡率(%)	ARR	NNBS (名)
胸部X线摄片^a	727	-	29574	2.46	-	0.91	2.24	-	0.0022	456
	-	5658	29574	-	19.13	0.97	-	18.56	0.0058	174
非影像学预防^b	388	-	14003	0.027	-	0.74	2.05	-	0.0072	139
	-	1460	14003	-	10.43	0.88	-	9.18	0.0125	81

因素	单因素模型 (P值)	多因素模型 (P值)
对照组(胸部X线摄片)	0.520	0.691
女性构成比	0.320	0.978
筛查轮数	0.175	0.713
中位随访时间	<0.001	0.009