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Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis.
Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2021 Aug 10; Vol. 39 (23), pp. 2574-2585. Date of Electronic Publication: 2021 Jun 02. - Publication Year :
- 2021
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Abstract
- Purpose: This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS.<br />Materials and Methods: Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach.<br />Results: Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women ( P = .21; I-squared = 33.6%).<br />Conclusion: Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.<br />Competing Interests: Francesco PassigliaConsulting or Advisory Role: AstraZeneca, MSD Oncology, AmgenTravel, Accommodations, Expenses: MSD Oncology, Roche Marzia Del ReConsulting or Advisory Role: Sanofi, Celgene, Janssen-Cilag, Ipsen, Roche Molecular DiagnosticsSpeakers' Bureau: Sanofi, Pfizer, Novartis, Janssen-Cilag, Ipsen, AstraZeneca, Astellas Pharma Francesco FacchinettiOther Relationship: Roche, Bristol Myers Squibb Roberto FerraraConsulting or Advisory Role: Merck Sharp & Dohme Tindara FranchinaHonoraria: Novartis, AstraZenecaConsulting or Advisory Role: Boehringer Ingelheim, Merck Sharp & Dohme Anna R. LariciSpeakers' Bureau: Boehringer Ingelheim Umberto MalapelleConsulting or Advisory Role: Boehringer Ingelheim, Roche, Merck Sharp & Dohme, Amgen, Thermo Fisher Scientific, Lilly, Diaceutics, GlaxoSmithKline, Merck, AstraZenecaSpeakers' Bureau: Boehringer Ingelheim, AstraZeneca, Roche, Merck Sharp & Dohme, Amgen, Merck, Thermo Fisher Scientific, Lilly, Diaceutics, GlaxoSmithKline Jessica MenisConsulting or Advisory Role: MSD Oncology, Roche/Genentech, Boehringer Ingelheim, AstraZeneca, Bristol Myers Squibb/PfizerSpeakers' Bureau: AstraZeneca/MedImmune, Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, MSD Oncology, Roche/GenentechTravel, Accommodations, Expenses: Boehringer Ingelheim Antonio PassaroConsulting or Advisory Role: Roche/Genentech, Bristol Myers Squibb, AstraZeneca, MSD Oncology, Pfizer, Boehringer IngelheimTravel, Accommodations, Expenses: Roche/Genentech, Bristol Myers Squibb Sara PilottoHonoraria: Bristol Myers Squibb, Boehringer Ingelheim, AstraZenecaSpeakers' Bureau: Bristol Myers Squibb, Boehringer Ingelheim, Roche, MSD Oncology, AstraZenecaResearch Funding: AstraZenecaTravel, Accommodations, Expenses: Bristol Myers Squibb, Roche, AstraZeneca Sara RamellaHonoraria: AstraZeneca, AmgenConsulting or Advisory Role: AstraZeneca, Roche, Ipsen Rocco TrisoliniHonoraria: Pentax Medical Devices Silvia NovelloConsulting or Advisory Role: SanofiSpeakers' Bureau: AstraZeneca, Merck Sharp & Dohme, Bristol Myers Squibb, Roche, Pfizer, Lilly, Takeda, AbbVie, Boehringer Ingelheim, Bayer, Amgen, BeigeneNo other potential conflicts of interest were reported.
- Subjects :
- Early Detection of Cancer
Female
Humans
Lung Neoplasms diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 39
- Issue :
- 23
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 34236916
- Full Text :
- https://doi.org/10.1200/JCO.20.02574