Mortality outcomes of low-dose computed tomography screening for lung cancer in urban China:a decision analysis and implications for practice

作     者：Zixing Wang Wei Han Weiwei Zhang Fang Xue Yuyan Wang Yaoda Hu Lei Wang Chunwu Zhou Yao Huang Shijun Zhao Wei Song Xin Sui Ruihong Shi Jingmei Jiang 

作者机构：Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Cancer Hospital Chinese Academy of Medical Sciences Peking Union Medical College HospitalChinese Academy of Medical Sciences National Institutes for Food and Drug Control State Food and Drug Administration 

出 版 物：《Chinese Journal of Cancer》 (Chinese Journal of Cancer)

年 卷 期：2017年第36卷第8期

页      面：367-379页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：supported by Peking Union Medical College Youth Fund and the Fundamental Research Funds for the Central Universities(No.2017310049) 

主　　题：Lung cancer Low-dose CT Screening Mortality outcome Decision analysis 

摘      要：Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening ***: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the ***: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.