背景：在肺癌筛查中选择随访测试的时间目标是具有挑战性的。我们的目标是设计动态的，通过低剂量计算机断层扫描检测到的肺结节患者的个性化肺癌筛查方案。
方法：我们使用来自国家肺部筛查试验的肺结节患者（年龄55-74岁）的数据开发并验证了动态模型。我们在基线（R0）预测了患者特定的风险概况，并在重复的筛选轮（R1和R2）中更新了风险评估结果。我们使用风险截止值来优化早期决策点（3个月）的时间依赖性敏感性和晚期决策点（1年）的时间依赖性特异性。
结果：在验证中，预测12个月肺癌发病的受试者工作特征曲线下面积在R0和R1-R2分别为0.867(95%置信区间:0.827-0.894)和0.807(0.765-0.948).个性化的模式，与国家综合癌症网络(NCCN)指南和肺-RADS相比，延迟诊断率较低(1.7%vs.1.7%与6.9%）和过度测试（4.9%与5.6%与5.6％）在R0，延迟诊断率较低（0.0％vs.18.2%vs.18.2%）和过度测试（2.6%与8.3%与7.3%）在R2。癌症患者中的早期测试建议使用个性化模式更频繁(与NCCN：29.8%与20.9%,p=0.0065;vs.肺RADS：33.2％vs.22.8%,p=0.0025),尤其是对女性来说,年龄≥65岁的患者，和部分实性或非实性结节。
结论：与基于规则的协议相比，个性化模式易于实现且更准确。结果突出了个性化方法在实现有效结节管理中的价值。
BACKGROUND: Selecting the time target for follow-up testing in lung cancer screening is challenging. We aim to devise dynamic, personalized lung cancer screening schema for patients with pulmonary nodules detected through low-dose computed tomography.
METHODS: We developed and validated dynamic models using data of pulmonary nodule patients (aged 55-74 years) from the National Lung Screening
Trial. We predicted patient-specific risk profiles at baseline (R0) and updated the risk evaluation results in repeated screening rounds (R1 and R2). We used risk cutoffs to optimize time-dependent sensitivity at an early decision point (3 months) and time-dependent specificity at a late decision point (1 year).
RESULTS: In validation, area under receiver operating characteristic curve for predicting 12-month lung cancer onset was 0.867 (95 % confidence interval: 0.827-0.894) and 0.807 (0.765-0.948) at R0 and R1-R2, respectively. The personalized schema, compared with National Comprehensive Cancer Network (NCCN) guideline and Lung-RADS, yielded lower rates of delayed diagnosis (1.7% vs. 1.7% vs. 6.9 %) and over-testing (4.9% vs. 5.6% vs. 5.6 %) at R0, and lower rates of delayed diagnosis (0.0% vs. 18.2% vs. 18.2 %) and over-testing (2.6% vs. 8.3% vs. 7.3 %) at R2. Earlier test recommendation among cancer patients was more frequent using the personalized schema (vs. NCCN: 29.8% vs. 20.9 %, p = 0.0065; vs. Lung-RADS: 33.2% vs. 22.8 %, p = 0.0025), especially for women, patients aged ≥65 years, and part-solid or non-solid nodules.
CONCLUSIONS: The personalized schema is easy-to-implement and more accurate compared with rule-based protocols. The results highlight value of personalized approaches in realizing efficient nodule management.
