Lung cancer screening with spiral CT Baseline results of the randomized DANTE trial

被引:154
作者
Infante, Maurizio [1 ]
Lutman, Fabio Romano [2 ]
Cavuto, Silvio [3 ]
Brambilla, Giorgio [2 ]
Chiesa, Giuseppe [5 ]
Passera, Eliseo [5 ]
Angeli, Enzo [6 ]
Chiarenza, Maurizio [7 ]
Aranzulla, Giuseppe [8 ]
Cariboni, Umberto [1 ]
Alloisio, Marco [1 ]
Incarbone, Matteo [1 ]
Testori, Alberto [1 ]
Destro, Anna [4 ]
Cappuzzo, Federico [9 ]
Roncalli, Massimo [4 ]
Santoro, Armando [9 ]
Ravasi, Gianluigi [1 ]
机构
[1] Ist Clin Humanitas, Dept Thorac Surg, I-20089 Milan, Italy
[2] Ist Clin Humanitas, Dept Radiol, I-20089 Milan, Italy
[3] Lega Italiana Lotta Contro & Tumori, Milan, Italy
[4] Ist Clin Humanitas, Dept Pathol, I-20089 Milan, Italy
[5] Humanitas Gavazzeni, Dept Thorac Surg, Bergamo, Italy
[6] Humanitas Gavazzeni, Dept Radiol, Bergamo, Italy
[7] Humanitas Catania Oncol Ctr, Dept Oncol, Milan, Italy
[8] Humanitas Catania Oncol Ctr, Dept Radiol, Milan, Italy
[9] Ist Clin Humanitas, Dept Oncol, I-20089 Milan, Italy
关键词
lung cancer; randomized trial; screening; spiral CT scan;
D O I
10.1016/j.lungcan.2007.08.040
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Despite the high survival rates reported for screening-detected cases, the potential of screening of high-risk subjects for reducing lung cancer mortality is still unproven. We herewith present the baseline results of a randomized trial comparing screening for lung cancer with annual spiral computed tomography (CT) versus a yearly clinical review. Methods: Mate subjects, 60-74 years old, and smokers of 20+ pack-years were enrolled. All participants received a baseline medical examination, chest X-rays (CXR) and sputum cytology upon accrual. Subjects randomized in the spiral CT group received a spiral CT scan at baseline, then yearly for the following 4 years. For controls, a yearly clinical examination was scheduled for the following 4 years. Results: 2472 subjects were randomized (1276 spiral CT arm, 1196 controls). Age, smoking exposure and co-morbid conditions were similar in the two groups. In the spiral CT group, 28 lung cancers were detected, 13 of which were visible in the baseline chest X-rays (overall prevalence 2.2%). Sixteen out of 28 tumours (57%) were stage 1, and 19 (68%) were resectable. In the control group, eight cases were detected by the baseline chest X-rays (prevalence rate 0.67%), four (50%) were stage I, and six (75%) were resectable. Conclusions: Baseline lung cancer detection rate in the spiral CT arm was higher than in most published studies. The stage I detection rate was increased four-fold by spiral CT versus chest Xrays. However, more tumours in an advanced stage were also detected by CT. The high resection rate of screening-detected patients suggests a possible increase in cure rate. However, longer follow-up is required for definitive conclusions. This trial has been registered at www.Clinicaltrials.gov, registration No. NCT00420862. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:355 / 363
页数:9
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