Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequenti
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RESEARCH ARTICLE
Open Access
Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis Kai-Lin Huang1,2, Shih-Yuan Wang1, Wan-Chen Lu1, Ya-Hui Chang1, Jian Su3,4*† and Yen-Ta Lu3,4*†
Abstract Background: The Nelson mortality results were presented in September 2018. Four other randomized control trials (RCTs) were also reported the latest mortality outcomes in 2018 and 2019. We therefore conducted a meta-analysis to update the evidence and investigate the benefits and harms of low-dose computed tomography (LDCT) in lung cancer screening. Methods: Detailed electronic database searches were performed to identify reports of RCTs that comparing LDCT to any other type of lung cancer screening. Pooled risk ratios (RRs) were calculated using random effects models. Results: We identified nine RCTs (n = 97,244 participants). In pooled analyses LDCT reduced lung cancer mortality (RR 0.83, 95% CI 0.76–0.90, I2 = 1%) but had no effect on all-cause mortality (RR 0.95, 95% CI 0.90–1.00). Trial sequential analysis (TSA) confirmed the results of our meta-analysis. Subgroup defined by high quality trials benefitted from LDCT screening in reducing lung cancer mortality (RR 0.82, 95% CI 0.73–0.91, I2 = 7%), whereas no benefit observed in other low quality RCTs. LDCT was associated with detection of a significantly higher number of early stage lung cancers than the control. No significant difference (RR 0.64, 95% CI 0.30–1.33) was found in mortality after invasive procedures between two groups. Conclusions: In meta-analysis based on sufficient evidence demonstrated by TSA suggests that LDCT screening is superiority over usual care in lung cancer survival. The benefit of LDCT is expected to be heavily influenced by the risk of lung cancer in the different target group (smoking status, Asian) being screened. Keywords: Low-dose computed tomography, LDCT, Lung cancer screening, Mortality, Meta-analysis
Background Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018 [1]. Lung cancer is the commonest form of cancer (2.09 million cases) as well as the main cause of cancer related mortality (1.76 million deaths) [1]. Due to the asymptomatic nature of lung cancer, they are often diagnosed at an advanced stage when the prognosis is poor or futile. In more recent years low-dose computed tomography (LDCT) has been * Correspondence: [email protected]; [email protected] † Jian Su and Yen-Ta Lu contributed equally to this work. 3 Department of Chest Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan Full list of author information is available at the end of the article
demonstrated to be a sensitive tool for the detection of early stage lung cancer [2]. However, researches also indicated that LDCT is associated with high false-positive rates in the diagnosis of lung cancer, resulting in unnecessary invasive procedures and patient anxiety [3–5]. In 2011, a high quality trial, the Na
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