低剂量螺旋CT对高危人群肺癌筛查价值的Meta分析

Role of low-dose spiral CT scan in lung cancer screening:a meta-analysis

目的应用Meta分析法综合评价低剂量螺旋CT(low-dose spiral computed tomography,LDCT)在肺癌筛查中的价值。方法在PubMed、Cochrane等数据库检索1996年至2010年期间的相关文献资料;根据纳入标准筛选符合条件的文献;对文献进行信息统计、科学性评估及质量分级;采用随机效应模型进行数据分析;通过似然比(likelihoodratio,LR)、加权灵敏度和特异度(pooled sensitivity and specificity)及汇总受试者工作特征曲线(summary receiveroperator characteristic curve,SROC曲线)等统计指标综合评价LDCT在肺癌筛查中的价值。结果共纳入12篇英文文献,由9个独立研究构成,研究对象28 024例。文献质量评估结果提示纳入文献质量较好;LDCT在肺癌筛查中价值的合并阳性似然比(+LR)为3.35,阴性似然比(-LR)为0.29,加权灵敏度为0.735(0.730～0.740),特异度为0.791(0.747～0.830),SROC曲线下面积(area under curve,AUC)为0.847 3。结论多数独立研究单位报道的LDCT在早期肺癌筛查中的价值评价一致。通过汇总相关研究结果显示,LDCT在早期肺癌筛查中具有较高的价值,但仍需要高质量的随机对照研究以更准确地评价其临床价值。

Objective To evaluate the value of low-dose spiral computed tomography（LDCT） in screening for lung cancer.Methods We searched for the relevant documentation from PubMed,ISI Web of Knowledge,Cochrane and other databases from 1996 to 2010 to screen eligible literature according to the inclusive criteria.We gathered relevant literature for statistical analysis evaluated its scientificness and classified its quality.We used the random effect model to analyze data;to evaluate the value of LDCT in screening for lung cancer comprehensively by the likelihood ratio（LR）,the pooled sensitivity,specificity and summary receiver operating characteristic curve（SROC curve） statistical indicators.Results Totally 12 pieces of English literature was collected,with 9 independent researches and a total of 28024 cases brought into the study.Heterogeneity test showed that the homogeneity of the study was good,which showed the quality of literature collected in this study was preferable;the value of the ＋ LR was 3.35,-LR was 0.29,the weighted sensitivity was 0.735（0.730-0.740）,the specificity was 0.791（0.747-0.830） and SROC area under the curve（AUC） was 0.8473 by using LDCT in screening lung cancer.Conclusion The reports of the most independent research on LDCT screening for lung cancer were consistent.Using LDCT to screen for lung cancer has a high value through the summary of relevant research results,but it still needs high-quality random control trial to assess its value in clinic more accurately.