LBPO.PS01 · 人群科学 · Late-Breaking
按Lung-RADS分类的CT筛查及随访依从性：一项多中心队列研究
Adherence to CT screening and follow-up by Lung-RADS category: A multicenter cohort study
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摘要 Abstract
中文摘要
背景：及时的筛查和随访护理对降低肺癌死亡率至关重要。然而，在真实世界实践中，基线扫描后对低剂量计算机断层扫描（LDCT）或任何CT筛查以及指南推荐随访的依从性仍然较差。本研究的目的是识别在Lung-RADS阴性和阳性各类别中与依从性相关的因素。
方法：我们对55-74岁成人开展了一项回顾性、多中心队列研究，这些成人在2016至2020年间接受了LDCT，在基线前有≥ 1次初级保健就诊，且在既往5年内无肺癌诊断。依从性定义遵循Lung-RADS管理指南。我们拟合了以中心为随机截距的混合效应逻辑回归模型，采用自适应Gauss-Hermite求积法（QPOINTS = 7）进行估计。
结果：在31,795例患者中，排除6279例，剩余21,275例Lung-RADS阴性（1-2）和4,241例Lung-RADS阳性（3-4X）患者。两组的依从性均较低：Lung-RADS 1-2为21.3%，Lung-RADS 3-4X为28.6%。在Lung-RADS 1-2患者中，年龄≥ 65岁者的依从性高于< 65岁者（OR 1.19；95% CI 1.10-1.28），患有COPD者依从性更高（OR 1.15；95% CI 1.06-1.24），但黑人患者的依从性低于白人患者（OR 0.87；95% CI 0.78-0.96），从不吸烟者的依从性低于当前吸烟者（OR 0.65；95% CI 0.53-0.79）。在Lung-RADS 3-4X患者中，COPD仍与依从性呈正相关（OR 1.19；95% CI 1.03-1.39），而与非衰弱状态相比，衰弱前期与较低的依从性相关（OR 0.80；95% CI 0.66-0.98）。大多数其他社会人口统计学和情境因素在校正模型中无统计学意义。
结论：阴性结果后对任何CT筛查的依从性以及阳性发现后对推荐随访的依从性仍然较差。年龄、种族、吸烟行为、COPD和衰弱相关的脆弱性影响依从性模式，凸显了需要有针对性的、以患者为中心的策略，以改善真实世界筛查项目中的留存和随访。
关键词：Lung-RADS、依从性、随访、肺癌
查看英文原文 English abstract
Background: Timely screening and follow-up care are critical for reducing lung cancer mortality. However, adherence to low-dose computed tomography (LDCT) or any CT screening and guideline-recommended follow-up remains poor in real-world practice after the baseline scan. The objective of this study is to identify factors associated with adherence across Lung-RADS negative and positive categories.
Methods: We conducted a retrospective, multi-site cohort study of adults aged 55-74 who underwent LDCT between 2016 and 2020, had ≥1 primary care visit before baseline, and had no lung cancer diagnosis in the prior 5 years. Adherence definitions followed Lung-RADS management guidelines. We fit mixed-effects logistic regression models with a random intercept for site, estimated using adaptive Gauss-Hermite quadrature (QPOINTS=7).
Results: Of 31,795 patients, 6279 were excluded, leaving 21,275 Lung-RADS negative (1-2) and 4,241 Lung-RADS positive (3-4X) patients. Adherence was low in both groups: 21.3% for Lung-RADS 1-2 and 28.6% for Lung-RADS 3-4X. Among Lung-RADS 1-2 patients, adherence was higher among those aged ≥65 (OR 1.19; 95% CI 1.10-1.28) compared with <65 years, and those with COPD (OR 1.15; 95% CI 1.06-1.24), but lower among Black patients compared with White patients (OR 0.87; 95% CI 0.78-0.96) and never smokers compared with current smokers (OR 0.65; 95% CI 0.53-0.79). Among Lung-RADS 3-4X patients, COPD remained positively associated with adherence (OR 1.19; 95% CI 1.03-1.39), while pre-frailty was associated with lower adherence compared with non-frail status (OR 0.80; 95% CI 0.66-0.98). Most other sociodemographic and contextual factors were not statistically significant in adjusted models.
Conclusions: Adherence to any CT screening after negative results and recommended follow-up after positive findings remains poor. Age, race, smoking behavior, COPD, and frailty-related vulnerability contribute to adherence patterns, highlighting the need for targeted, patient-centered strategies to improve retention and follow-up in real-world screening programs.
Keywords: Lung-RADS, adherence, follow-up, lung cancer
利益披露 Disclosure
P. Shrestha, None..
M. K. Gould, None..
X. Lou, None..
G. A. Silvestri, None..
D. Braithwaite, None..
S. D. Karanth, None.