低剂量胸部CT联合循环肿瘤细胞筛查在有吸烟史且合并外周动脉疾病的患者中检测癌症:一项前瞻性多中心队列研究
Combined low-dose thoracic computed tomography and circulating tumor cell screening for cancer in ever smokers with peripheral arterial disease: A prospective multicenter cohort study.
作者
作者单位
- Vascular Medicine Department, Paris Saint-Joseph Hospital Group, France; Paris Cité University, INSERM UMR 1153-CRESS, Paris, France. Electronic address: alexandra.yannoutsos@gmail.com.
- Department of Pulmonology and Intensive Care, Georges Pompidou European Hospital, AP-HP, Paris, France.
- Department of Pathology, Cochin AP-HP-Paris Centre, Paris-Cité University, INSERM U1138, Paris, France.
- Vascular Medicine Department, Paris Saint-Joseph Hospital Group, France.
- Clinical Research Department, Paris Saint-Joseph Hospital Group, France.
- Department of Radiology, Paris Saint-Joseph Hospital Group, France.
- Vascular Medicine Department, Georges Pompidou European Hospital, AP-HP, Paris, France.
- Department of Pathology, Paris Saint-Joseph Hospital Group, France.
- Rarecells, Faculté de Médecine Necker Enfants Malades, Paris, France.
- Department of Pathology, Cochin AP-HP-Paris Centre, Paris-Cité University, Paris, France.
- Department of Thoracic Oncology, Paris Saint-Joseph Hospital Group, France.
- Vascular Medicine Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Cité University, INSERM PARCC U970, Paris, France.
摘要
中文
外周动脉疾病(PAD)患者癌症相关死亡率高。我们旨在评估低剂量胸部计算机断层扫描(LDCT)联合循环肿瘤细胞(CTC)检测对PAD患者进行癌症筛查的策略。2017年1月1日至2020年6月30日期间在法国进行了一项前瞻性多中心队列研究。符合条件的PAD患者年龄55-80岁,吸烟史≥30包年(当前吸烟者或过去15年内戒烟者)。计划连续三轮年度筛查,结合LDCT和CTC检测。患者总共随访3年。主要结局是这种联合筛查策略的诊断性能。在入组的149例曾吸烟PAD患者中(中位年龄66岁[60.4-71.0];114例[76.5%]男性),首轮筛查诊断出9例癌症。3年后,共在18例患者(12.1%)中诊断出10例肺癌和8例肺外癌:LDCT检测到9例肺癌和1例肺外癌(肺转移),而6例肺癌患者和4例肺外癌患者检出CTC。联合筛查策略检测到10例肺癌以及8例肺外癌中的5例,敏感性为83.3%(95%CI 66.1-100),特异性为45.0%(95%CI 36.5-53.6)。有吸烟史的PAD患者表现出较高的肺和肺外癌症患病率。LDCT联合CTC检测的筛查策略可能改善这一高危人群的早期诊断。需要更大规模的研究来验证该方法在临床筛查计划中的应用。
English
Patients with peripheral arterial disease (PAD) present a high risk of cancer-related mortality. We aimed to evaluate a screening approach combining low-dose thoracic computed tomography (LDCT) and circulating tumor cell (CTC) search for cancer detection in PAD patients. A prospective multicenter cohort study was conducted in France between January 1, 2017, and June 30, 2020. Eligible PAD patients were aged 55-80 years, with a smoking history ≥ 30 pack-years (current or smoking cessation within the past 15 years). Three consecutive annual screening rounds were planned combining LDCT and CTC detection. Patients were followed-up for a total of three years. Primary outcome was the diagnostic performance of this combined screening strategy. Among 149 ever-smoker PAD patients enrolled (median age 66 years [60.4-71.0]; 114 [76.5 %] men), nine cancers were diagnosed at first screening round. After three years, a total of ten lung and eight extrapulmonary cancers were diagnosed in 18 patients (12.1 %): LDCT detected nine lung cancers and one extrapulmonary cancer (pulmonary metastasis), while CTCs were found in six lung cancer patients and in four with extrapulmonary cancer. Combined screening strategy allowed to detect ten lung cancers plus five of eight extrapulmonary cancers, yielding a sensitivity of 83.3 % (95 % CI 66.1-100) and specificity of 45.0 % (95 % CI 36.5-53.6). Ever smokers with PAD demonstrated a high prevalence of pulmonary and extrapulmonary cancers. Screening strategy combining LDCT and CTC detection may improve early diagnosis in this high-risk population. Larger studies are warranted to validate this approach in clinical screening programs.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3
- 新锐分区
- 2区