Can CT Screening Give Rise to a Beneficial Stage Shift in Lung Cancer Patients? Systematic Review and Meta-Analysis

Abstract

ObjectivesTo portray the stage characteristics of lung cancers detected in CT screenings, and explore whether there’s universal stage superiority over other methods for various pathological types using available data worldwide in a meta-analysis approach.Materials and MethodsEMBASE and MEDLINE were searched for studies on lung cancer CT screening in natural populations through July 2015 without language or other filters. Twenty-four studies (8 trials and 16 cohorts) involving 1875 CT-detected lung cancer patients were enrolled and assessed by QUADAS-2. Pathology-confirmed stage information was carefully extracted by two reviewers. Stage I or limited stage proportions were pooled by random effect model with Freeman-Tukey double arcsine transformation.ResultsPooled stage I cancer proportion in CT screenings was 73.2% (95% confidence interval: 68.6%, 77.5%), with a significant rising trend (Ptrend<0.05) from baseline (64.7%) to ≥5 repeat rounds (87.1%). Relative to chest radiograph and usual care, the increased stage I proportions in CT were 12.2% (P>0.05), and 46.5% (P<0.05), respectively. Pathology-specifically, adenocarcinomas (66%) and squamous cell lung cancers (17%) composed the majority of CT-detected lung cancers, and had significantly higher stage I proportions relative to chest radiograph (bronchioloalveolar adenocarcinomas, 80.9% vs 51.4%; other adenocarcinomas, 58.8% vs 38.3%; squamous cell lung cancers, 52.3% vs 38.3%; all P<0.05). However, the percentage of small cell lung cancer was lower using CT than other detection routes, and no significant difference in limited stage proportion was observed (6.8% vs 10.8%, P>0.05).ConclusionCT screening can detect more early stage non-small cell lung cancers, but not all of them could be beneficial as there are a considerable number of indolent ones such as bronchioloalveolar adenocarcinomas. Still, current evidence is lacking regarding small cell lung cancers.

Challenges and research opportunities for lung cancer screening in China

“…The high heterogeneity of cancer is another issue that has important implications for lung cancer screening. According to our recent meta-analysis [ 18 ], indolent cancers contributed to over-diagnosis, as they comprised a large proportion of cancers additionally detected with LDCT. In addition, no evidence of superiority with LDCT for the early detection of small cell lung cancers was observed, unlike non-small cell lung cancers.…”

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

“…A kisebb vizsgálatok összesített eredménye nem mutatott ki szignifikáns mortalitáscsökkenést az LDCT-vel szűrt karon, a legnagyobb randomizált, kontrollcsoportos vizsgálat viszont 20%-os relatívkockázat-csökkenésről számolt be. Wang és mtsai nyolc vizsgálatot válogattak be az elemzésükbe, amely az alacsony dózisú CT-vel történő szűrésnek a tüdőrák felfedezéskori stádiumára vonatkozó pozitív hatására szolgáltat bizonyítékot [10]. Az első stádiumban felfedezett tüdőrákok aránya 12,2%-kal volt magasabb az LDCT-vel szűrt betegek esetén a mellkasröntgenhez képest, és 46,5%-kal a nem szűrt betegekhez viszonyítva.…”

“…Több nagy, randomizált, kontrollcsoportos vizsgálat sem tudta igazolni, hogy a mellkas-röntgenfelvétellel való tüdőszűrés csökkentené a tüdőrákos mortalitást a nem szűrt csoporthoz képest [7,8]. Emellett nemrég publikált szisztematikus irodalomkutatás és metaanalízisek eredményei is azt bizonyít-ják, hogy a mellkasröntgennel végzett eljárás nem haté-kony módja a célzott tüdőrákszűrésnek [9,10]. Hiába csökken ugyanis a reszekábilis stádiumban felfedezett betegek aránya, ha eközben a kedvezőtlen tesztkarakterisztikák miatt a szűrési eljárás hatásossága alacsony és nem javul a betegek életesélye.…”

More Health Outcomes Analysis from More Representative Population Data Is Necessary prior to Bronchial Genomic Classifier Application in Real Practice

“…1 Both the population lost to follow-up and the population of patients with an incomplete diagnosis had a smaller lesion size compared with the counterpart final inclusion population. A recent meta-analysis by Wang et al 3 identified temporal trends of a proportion regarding increased stage I lung cancer since the worldwide introduction of CT screening. In response to the anticipated temporal increases of CT screening since the approval for coverage by the Centers for Medicare and Medicaid Services in 2015, the proportion of early-stage cancer or nonmalignant cases in the United States is anticipated to increase.…”