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Abstract：
The role of total plasma cell-free DNA (cfDNA) in lung cancer (LC) screening with low-dose computed tomography (LDCT) is uncertain. We hypothesized that cfDNA could support differentiation between malignant and benign nodules observed in LDCT. The baseline cfDNA was measured in 137 subjects of the ITALUNG trial, including 29 subjects with screen-detected LC (17 prevalent and 12 incident) and 108 subjects with benign nodules. The predictive capability of baseline cfDNA to differentiate malignant and benign nodules was compared to that of Lung-RADS classification and Brock score at initial LDCT (iLDCT). Subjects with prevalent LC showed both well-discriminating radiological characteristics of the malignant nodule (16 of 17 were classified as Lung-RADS 4) and markedly increased cfDNA (mean 18.8 ng/mL). The mean diameters and Brock scores of malignant nodules at iLDCT in subjects who were diagnosed with incident LC were not different from those of benign nodules. However, 75% (9/12) of subjects with incident LC showed a baseline cfDNA ≥ 3.15 ng/mL, compared to 34% (37/108) of subjects with benign nodules (p = 0.006). Moreover, baseline cfDNA was correlated (p = 0.001) with tumor growth, measured with volume doubling time. In conclusion, increased baseline cfDNA may help to differentiate subjects with malignant and benign nodules at LDCT.
摘要：
血浆总无细胞DNA（cfDNA）在低剂量计算机断层扫描（LDCT）筛查肺癌（LC）中的作用尚不确定。我们假设cfDNA可以支持LDCT中观察到的恶性和良性结节之间的区别。在ITALUNG试验的137名受试者中测量了基线cfDNA，包括29例筛查LC的受试者（17例流行和12例事件）和108例良性结节的受试者。将基线cfDNA区分恶性和良性结节的预测能力与初始LDCT（iLDCT）时的Lung-RADS分类和Brock评分进行比较。患有普遍LC的受试者显示出良好的恶性结节放射学特征（17个中的16个被分类为Lung-RADS4）和显着增加的cfDNA（平均18.8ng/mL）。在诊断为偶发LC的受试者中，iLDCT恶性结节的平均直径和Brock评分与良性结节没有差异。然而,75%（9/12）的LC患者显示基线cfDNA≥3.15ng/mL，相比之下，34%(37/108)的受试者患有良性结节(p=0.006)。此外，基线cfDNA与肿瘤生长相关（p=0.001），用体积倍增时间测量。总之,基线cfDNA升高可能有助于LDCT患者区分恶性和良性结节.
