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Meta-Analysis
. 2021 Aug 10;39(23):2574-2585.
doi: 10.1200/JCO.20.02574. Epub 2021 Jun 2.

Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis

Francesco Passiglia  1 , Michela Cinquini  2 , Luca Bertolaccini  3 , Marzia Del Re  4 , Francesco Facchinetti  5 , Roberto Ferrara  6 , Tindara Franchina  7 , Anna R Larici  8 , Umberto Malapelle  9 , Jessica Menis  10   11 , Antonio Passaro  12 , Sara Pilotto  13 , Sara Ramella  14 , Giulio Rossi  15 , Rocco Trisolini  16 , Silvia Novello  1
Affiliations
Meta-Analysis

Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis

Francesco Passiglia et al. J Clin Oncol. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Clin Oncol. 2021 Oct 1;39(28):3192-3193. doi: 10.1200/JCO.21.02078. J Clin Oncol. 2021. PMID: 34582704 No abstract available.

Abstract

Purpose: This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS.

Materials and methods: Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach.

Results: Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women (P = .21; I-squared = 33.6%).

Conclusion: Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.

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Conflict of interest statement

Francesco PassigliaConsulting or Advisory Role: AstraZeneca, MSD Oncology, AmgenTravel, Accommodations, Expenses: MSD Oncology, Roche Marzia Del ReConsulting or Advisory Role: Sanofi, Celgene, Janssen-Cilag, Ipsen, Roche Molecular DiagnosticsSpeakers' Bureau: Sanofi, Pfizer, Novartis, Janssen-Cilag, Ipsen, AstraZeneca, Astellas Pharma Francesco FacchinettiOther Relationship: Roche, Bristol Myers Squibb Roberto FerraraConsulting or Advisory Role: Merck Sharp & Dohme Tindara FranchinaHonoraria: Novartis, AstraZenecaConsulting or Advisory Role: Boehringer Ingelheim, Merck Sharp & Dohme Anna R. LariciSpeakers' Bureau: Boehringer Ingelheim Umberto MalapelleConsulting or Advisory Role: Boehringer Ingelheim, Roche, Merck Sharp & Dohme, Amgen, Thermo Fisher Scientific, Lilly, Diaceutics, GlaxoSmithKline, Merck, AstraZenecaSpeakers' Bureau: Boehringer Ingelheim, AstraZeneca, Roche, Merck Sharp & Dohme, Amgen, Merck, Thermo Fisher Scientific, Lilly, Diaceutics, GlaxoSmithKline Jessica MenisConsulting or Advisory Role: MSD Oncology, Roche/Genentech, Boehringer Ingelheim, AstraZeneca, Bristol Myers Squibb/PfizerSpeakers' Bureau: AstraZeneca/MedImmune, Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, MSD Oncology, Roche/GenentechTravel, Accommodations, Expenses: Boehringer Ingelheim Antonio PassaroConsulting or Advisory Role: Roche/Genentech, Bristol Myers Squibb, AstraZeneca, MSD Oncology, Pfizer, Boehringer IngelheimTravel, Accommodations, Expenses: Roche/Genentech, Bristol Myers Squibb Sara PilottoHonoraria: Bristol Myers Squibb, Boehringer Ingelheim, AstraZenecaSpeakers' Bureau: Bristol Myers Squibb, Boehringer Ingelheim, Roche, MSD Oncology, AstraZenecaResearch Funding: AstraZenecaTravel, Accommodations, Expenses: Bristol Myers Squibb, Roche, AstraZeneca Sara RamellaHonoraria: AstraZeneca, AmgenConsulting or Advisory Role: AstraZeneca, Roche, Ipsen Rocco TrisoliniHonoraria: Pentax Medical Devices Silvia NovelloConsulting or Advisory Role: SanofiSpeakers' Bureau: AstraZeneca, Merck Sharp & Dohme, Bristol Myers Squibb, Roche, Pfizer, Lilly, Takeda, AbbVie, Boehringer Ingelheim, Bayer, Amgen, BeigeneNo other potential conflicts of interest were reported.

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