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Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis

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 c...

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Autores principales: Huang, Kai-Lin, Wang, Shih-Yuan, Lu, Wan-Chen, Chang, Ya-Hui, Su, Jian, Lu, Yen-Ta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625016/
https://www.ncbi.nlm.nih.gov/pubmed/31296196
http://dx.doi.org/10.1186/s12890-019-0883-x
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author Huang, Kai-Lin
Wang, Shih-Yuan
Lu, Wan-Chen
Chang, Ya-Hui
Su, Jian
Lu, Yen-Ta
author_facet Huang, Kai-Lin
Wang, Shih-Yuan
Lu, Wan-Chen
Chang, Ya-Hui
Su, Jian
Lu, Yen-Ta
author_sort Huang, Kai-Lin
collection PubMed
description 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, I(2) = 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, I(2) = 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-019-0883-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-66250162019-07-23 Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis Huang, Kai-Lin Wang, Shih-Yuan Lu, Wan-Chen Chang, Ya-Hui Su, Jian Lu, Yen-Ta BMC Pulm Med Research Article 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, I(2) = 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, I(2) = 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-019-0883-x) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-11 /pmc/articles/PMC6625016/ /pubmed/31296196 http://dx.doi.org/10.1186/s12890-019-0883-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Huang, Kai-Lin
Wang, Shih-Yuan
Lu, Wan-Chen
Chang, Ya-Hui
Su, Jian
Lu, Yen-Ta
Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title_full Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title_fullStr Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title_full_unstemmed Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title_short Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
title_sort effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625016/
https://www.ncbi.nlm.nih.gov/pubmed/31296196
http://dx.doi.org/10.1186/s12890-019-0883-x
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