Abstract：
BACKGROUND: Despite randomized trials demonstrating a mortality benefit to low-dose computed tomography screening to detect lung cancer, uptake of lung cancer screening (LCS) has been slow, and the benefits of screening remain unclear in clinical practice.
METHODS: This study aimed to assess the impact of screening among patients in the Veterans Health Administration (VA) health care system diagnosed with lung cancer between 2011 and 2018. Lung cancer stage at diagnosis, lung cancer-specific survival, and overall survival between patients with cancer who did and did not receive screening before diagnosis were evaluated. We used Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes.
RESULTS: Of 57,919 individuals diagnosed with lung cancer in the VA system between 2011 and 2018, 2167 (3.9%) underwent screening before diagnosis. Patients with screening had higher rates of stage I diagnoses (52% vs. 27%; p ≤ .0001) compared to those who had no screening. Screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer-specific survival (59.0% vs. 29.7%) compared to unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline-concordant treatment, screening resulted in substantial reductions in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.67-0.92; p = .003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; p < .001).
CONCLUSIONS: While LCS uptake remains limited, screening was associated with earlier stage diagnoses and improved survival. This large national study corroborates the value of LCS in clinical practice; efforts to widely adopt this vital intervention are needed.
METHODS: This study aimed to assess the impact of screening among patients in the Veterans Health Administration (VA) health care system diagnosed with lung cancer between 2011 and 2018. Lung cancer stage at diagnosis, lung cancer-specific survival, and overall survival between patients with cancer who did and did not receive screening before diagnosis were evaluated. We used Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes.
RESULTS: Of 57,919 individuals diagnosed with lung cancer in the VA system between 2011 and 2018, 2167 (3.9%) underwent screening before diagnosis. Patients with screening had higher rates of stage I diagnoses (52% vs. 27%; p ≤ .0001) compared to those who had no screening. Screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer-specific survival (59.0% vs. 29.7%) compared to unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline-concordant treatment, screening resulted in substantial reductions in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.67-0.92; p = .003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; p < .001).
CONCLUSIONS: While LCS uptake remains limited, screening was associated with earlier stage diagnoses and improved survival. This large national study corroborates the value of LCS in clinical practice; efforts to widely adopt this vital intervention are needed.
摘要：
背景：尽管随机试验证明低剂量计算机断层扫描筛查肺癌对死亡率有益处，肺癌筛查（LCS）的摄取一直很慢，筛查的益处在临床实践中仍不清楚.
方法：本研究旨在评估2011年至2018年间退伍军人健康管理局（VA）医疗保健系统中诊断为肺癌的患者筛查的影响。肺癌诊断阶段，肺癌特异性生存率，评估诊断前接受筛查和未接受筛查的癌症患者的总生存期.我们使用Cox回归模型和逆倾向加权分析以及前置时间偏差调整来将LCS暴露与患者预后相关联。
结果：在2011年至2018年期间，在VA系统中诊断为肺癌的57,919名患者中，有2167名（3.9％）在诊断前接受了筛查。筛查患者的I期诊断率较高(52%vs.27%；p≤0.0001)与没有筛查的人相比。筛选的患者5年总生存率提高（50.2%vs.27.9%）和5年肺癌特异性生存率（59.0%vs.29.7%）与未筛查患者相比。在接受国家综合癌症网络指南一致治疗的筛选合格患者中，筛查导致全因死亡率大幅降低(调整后的风险比[AHR]，0.79；95%置信区间[CI]，0.67-0.92；p=0.003）和肺特异性死亡率（aHR，0.61；95%CI，0.50-0.74；p<.001）。
结论：虽然LCS摄取仍然有限，筛查与早期诊断和提高生存率相关.这项大型的全国性研究证实了LCS在临床实践中的价值；需要努力广泛采用这种重要的干预措施。
方法：本研究旨在评估2011年至2018年间退伍军人健康管理局（VA）医疗保健系统中诊断为肺癌的患者筛查的影响。肺癌诊断阶段，肺癌特异性生存率，评估诊断前接受筛查和未接受筛查的癌症患者的总生存期.我们使用Cox回归模型和逆倾向加权分析以及前置时间偏差调整来将LCS暴露与患者预后相关联。
结果：在2011年至2018年期间，在VA系统中诊断为肺癌的57,919名患者中，有2167名（3.9％）在诊断前接受了筛查。筛查患者的I期诊断率较高(52%vs.27%；p≤0.0001)与没有筛查的人相比。筛选的患者5年总生存率提高（50.2%vs.27.9%）和5年肺癌特异性生存率（59.0%vs.29.7%）与未筛查患者相比。在接受国家综合癌症网络指南一致治疗的筛选合格患者中，筛查导致全因死亡率大幅降低(调整后的风险比[AHR]，0.79；95%置信区间[CI]，0.67-0.92；p=0.003）和肺特异性死亡率（aHR，0.61；95%CI，0.50-0.74；p<.001）。
结论：虽然LCS摄取仍然有限，筛查与早期诊断和提高生存率相关.这项大型的全国性研究证实了LCS在临床实践中的价值；需要努力广泛采用这种重要的干预措施。
