Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis
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 lo...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12890-019-0883-x |
| _version_ | 1819162714633666560 |
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| author | Kai-Lin Huang Shih-Yuan Wang Wan-Chen Lu Ya-Hui Chang Jian Su Yen-Ta Lu |
| author_facet | Kai-Lin Huang Shih-Yuan Wang Wan-Chen Lu Ya-Hui Chang Jian Su Yen-Ta Lu |
| author_sort | Kai-Lin Huang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T17:32:38Z |
| format | Article |
| id | doaj.art-71a76bbb37554f72878f3e1d62f20a7c |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-22T17:32:38Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-71a76bbb37554f72878f3e1d62f20a7c2022-12-21T18:18:35ZengBMCBMC Pulmonary Medicine1471-24662019-07-0119111110.1186/s12890-019-0883-xEffects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysisKai-Lin Huang0Shih-Yuan Wang1Wan-Chen Lu2Ya-Hui Chang3Jian Su4Yen-Ta Lu5Department of Pharmacy, MacKay Memorial HospitalDepartment of Pharmacy, MacKay Memorial HospitalDepartment of Pharmacy, MacKay Memorial HospitalDepartment of Pharmacy, MacKay Memorial HospitalDepartment of Chest Medicine, MacKay Memorial HospitalDepartment of Chest Medicine, MacKay Memorial HospitalAbstract 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.http://link.springer.com/article/10.1186/s12890-019-0883-xLow-dose computed tomographyLDCTLung cancer screeningMortalityMeta-analysis |
| spellingShingle | Kai-Lin Huang Shih-Yuan Wang Wan-Chen Lu Ya-Hui Chang Jian Su Yen-Ta Lu Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis BMC Pulmonary Medicine Low-dose computed tomography LDCT Lung cancer screening Mortality Meta-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 | Low-dose computed tomography LDCT Lung cancer screening Mortality Meta-analysis |
| url | http://link.springer.com/article/10.1186/s12890-019-0883-x |
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