Data from the National Lung Screening Trial (NLST)

Background: The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer.
Methods: From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. This dataset includes the low-dose CT scans from 26,254 of these subjects, as well as digitized histopathology images from 451 subjects.
Results: The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02).
Conclusions: Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).

研究背景：肺癌具有侵袭性与异质性的特征，这阻碍了学界通过筛查手段降低该病死亡率的相关尝试。低剂量螺旋计算机断层扫描（low-dose helical computed tomography）的问世改变了肺癌筛查的格局，多项研究表明该技术可在早期阶段检出多数肿瘤。全国肺癌筛查试验（National Lung Screening Trial，NLST）旨在评估低剂量CT筛查能否降低肺癌死亡率。
研究方法：2002年8月至2004年4月，研究团队于美国33个医学中心招募了53454名肺癌高危人群。受试者被随机分为两组，分别接受为期3年、每年1次的低剂量CT筛查（26722名受试者）或单体位后前位胸部X线摄影（single-view posteroanterior chest radiography）筛查（26732名受试者）。研究收集了截至2009年12月31日的肺癌发病及肺癌死亡数据。本数据集包含其中26254名受试者的低剂量CT扫描影像，以及451名受试者的数字化组织病理学图像（digitized histopathology images）。
研究结果：筛查依从率超过90%。三轮筛查全程中，低剂量CT组的筛查阳性率为24.2%，胸部X线摄影组为6.9%。低剂量CT组中96.4%的筛查阳性结果、胸部X线摄影组中94.5%的筛查阳性结果均为假阳性结果。低剂量CT组的肺癌发病率为每10万人年645例（共1060例肺癌），胸部X线摄影组为每10万人年572例（共941例肺癌），率比为1.13（95%置信区间[CI]：1.03~1.23）。低剂量CT组的肺癌死亡率为每10万人年247例，胸部X线摄影组为每10万人年309例，提示低剂量CT筛查可使肺癌死亡率相对降低20.0%（95%CI：6.8~26.7；P=0.004）。与胸部X线摄影组相比，低剂量CT组的全因死亡率降低6.7%（95%CI：1.2~13.6；P=0.02）。
研究结论：低剂量CT筛查可降低肺癌死亡率。本研究由美国国家癌症研究所资助；全国肺癌筛查试验的ClinicalTrials.gov注册号为NCT00047385。

搜集汇总

背景与挑战

背景概述

该数据集来源于国家肺癌筛查试验（NLST），包含26,254名高风险参与者的低剂量CT扫描图像和451名参与者的数字化组织病理学图像，用于研究低剂量CT筛查对肺癌死亡率的影响。试验结果表明，与胸片筛查相比，低剂量CT筛查能显著降低肺癌死亡率20.0%，并减少总体死亡率6.7%，但假阳性率较高。数据集支持肺癌早期检测和筛查效果的分析。