Results of low-dose computed tomography as a regular health examination among Chinese hospital employees

Zhang, Yang; Jheon, Sanghoon; Li, Huimin; Zhang, Huibiao; Xie, Yaozeng; Qian, Bin; Lin, Kaihong; Wang, Shengping; Fu, Chuanxi; Hu, Hong; Zheng, Ying; Li, Yuan; Chen, Haiquan

doi:10.1016/j.jtcvs.2019.10.145

Cited by 107 publications

(96 citation statements)

References 21 publications

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“…In subset analysis by age, the lung cancer detection rates were 1.0, 2.6, and 2.9% in the "age ≤ 40 years, " "40 < age ≤ 55 years, " and "age > 55 years" group, respectively (63). According to this substantial data, Zhang proposed that the "high-risk" population for lung cancer is changing, and more lung cancers from the traditionally "low-risk" groups, such as young female non-smokers, could be detected by LDCT (63). These finding are completely consistent with our study.…”

Section: Discussionsupporting

confidence: 91%

“…Our data demonstrate that the clinical characteristics of GGO lung cancer patients may be out of the high-risk factors who are inappropriate for the lung cancer screening. Zhang et al performed LDCT for 8,329 hospital employees from different regions, and 179 cases were pathologically confirmed lung cancer and 98.9% (171) cases presented with GGO (63). In Zhang's study, there was a higher lung cancer detection rate in female than male patients (2.5 vs. 1.3%), and the lung cancer detection rate of non-smokers was also high than smokers (2.2 vs. 1.4%).…”

Section: Discussionmentioning

confidence: 99%

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The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis

Ren

Wang

et al. 2020

Front. Oncol.

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Introduction: Due to the introduction of low-dose computed tomography (CT) and screening procedures, the proportion of early-stage lung cancer with ground glass opacity (GGO) manifestation is increasing in clinical practice. However, its epidemiological characteristics is still not fully investigated. Methods: We retrieved all solitary GGO adenocarcinoma lung cancer (ADLC) on the PubMed, Cochrane Library, and Embase databases until January 1, 2019 and extracted the general information to perform the meta-analysis, mainly focusing on age, gender, and smoking status. Results: A total of 8,793 solitary GGO ADLC patients from 53 studies were included in this analysis. The final pooled analysis showed that the female proportion, average diagnosis age, and non-smoking proportion of solitary GGO ADLC was 0.62 (95% CI, 0.60-0.64), 56.97 (95% CI, 54.56-59.37), and 0.72 (95% CI, 0.66-0.77), respectively. The cumulative meta-analysis and meta-trend analysis confirmed that the average age at diagnosis has been decreasing while the non-smoking proportion significantly increased in the past two decades. Conclusions: From our epidemiological analysis, it demonstrates that the clinical characteristics of GGO lung cancer patients may be out of the high-risk factors. Therefore, we propose to reconsider the risk assessment and current lung cancer screening criteria.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis

Ren

Wang

et al. 2020

Front. Oncol.

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“…Furthermore, the age range typically focuses on the 55-to 80-year age range-the age range recommended by the US Preventive Services Task Force. 5 The present screening study by Zhang and colleagues, 6 however, extends the use of screening to a much broader population-to essentially "on-demand" screening.…”

mentioning

confidence: 80%

Commentary: On-demand computed tomography screening for lung cancer—some surprising results

Whyte

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…The second implicating finding is that 96% of detected lung cancer on LDCT presented as ground-glass opacities (GGOs), 3 which was not described in previous studies. Only 9.7% of participants in the NSLT presented with subsolid nodules.…”

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confidence: 90%

“…9 The histologic types of lung cancer detected by LDCT in this study were mainly adenocarcinoma (99%) at early stage (95% before stage Ib), more as adenocarcinoma in situ (26%) and minimally invasive adenocarcinoma (37%), less as invasive adenocarcinoma (36%). 3 Based on previous studies, these patients have 5-year disease-free survival rates of 100% if these nonsolid nodules are completely resected. 10 Data suggest that many nonsolid nodules can resolve, although they need to be followed.…”

mentioning

confidence: 98%

Commentary: The role of low-dose computed tomography for lung cancer screening among the nonsmoking Asian population

Lee

2020

The Journal of Thoracic and Cardiovascular Surgery

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Currently, lung cancer screening using low-dose computed tomography (LDCT) is recommended for heavy smokers in North America, Europe, and some countries in Asia. Both the NSLT and NELSON trials revealed a significant reduction of lung cancer mortality in the high-risk group. The incidence of lung cancer reported by the NSLT was 645 cases per 100,000 person-years (1060 cancers) in the LDCT group 1 and 8.9 detected cancers per 1000 screened in the NELSON trial. 2 The previous 2 large cohorts enrolled patients with high lung cancer risk, including smoking history and age, but the percentage of the Asian population was less than 5%. Zhang and colleagues 3 demonstrated that the lung cancer detection rate was as high as 2%, surprisingly in both female and nonsmoking employees. Evidence has shown that the incidence of lung cancer among neversmokers is increasing. [4][5][6][7] It is estimated that 10% to 25% of lung cancer occurs in never-smokers, and the prevalence is relatively high in East Asian women. 8 The NSLT and NELSON trials demonstrated the effectiveness of LDCT screening in smokers, but the effectiveness of LDCT screening among never-smokers is unknown. Recently, the TALENT study in Taiwan enrolled more than 10,397 participants who were nonsmokers, mainly female, with at least 1 potential lung cancer risk, including environmental exposure, tuberculosis/chronic obstructive pulmonary disease, cooking, and family history. The lung cancer detection rate in this population was 2.42% (data not published yet). These findings again remind us of that the different risk factors of lung cancer between the Asian and the Western populations. Therefore, the risk prediction model generated from the studies of Western countries may not be suitable to be directly adapted to the Asian population. The necessity and efficacy of LDCT screening in Asian never-smokers should be verified in the future.The second implicating finding is that 96% of detected lung cancer on LDCT presented as ground-glass opacities (GGOs), 3 which was not described in previous studies. Only 9.7% of participants in the NSLT presented with subsolid nodules. 9 The histologic types of lung cancer detected by LDCT in this study were mainly adenocarcinoma (99%) at early stage (95% before stage Ib), more as adenocarcinoma in situ (26%) and minimally invasive adenocarcinoma (37%), less as invasive adenocarcinoma (36%). 3 Based on previous studies, these patients have 5-year disease-free survival rates of 100% if these nonsolid nodules are completely resected. 10 Data suggest that many nonsolid nodules can resolve, although they need to be followed. 9,11 When assessing subsequent LDCT scans, the most important radiologic factor is change or stability of nodules compared with a previous imaging study. 12 Zhang and colleagues 3 did not provide a clear definition of a positive finding and did not regulate the follow-up strategy of the incidentally found GGOs to tell the natural course of the GGOs lesion but only based on principle. The definition of a positive findin...

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Results of low-dose computed tomography as a regular health examination among Chinese hospital employees

Cited by 107 publications

References 21 publications

The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis

The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis

Commentary: On-demand computed tomography screening for lung cancer—some surprising results

Commentary: The role of low-dose computed tomography for lung cancer screening among the nonsmoking Asian population

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