肺癌筛查和戒烟：来自于荷兰-比利时肺癌筛查随机对照试验中2年的随访数据
2010/09/14
摘要
背景：肺癌筛查可能为吸烟者戒烟提供一个新的机会，或者可能延迟戒烟。但目前尚未有研究提供相关证据。本试验在参与荷兰-比利时肺癌筛查随机对照试验（NELSON）的男性吸烟者中，研究肺癌筛查对戒烟的影响。
方法：在NELSON 研究中，参与者年龄为50～75岁，有罹患肺癌的高风险。对该研究中男性吸烟者的两个随机样本进行研究：筛查组（n=641）和对照组（n=643）。在研究开始前和随机分组后2年(T1)，评价其吸烟行为。虽然除了持续吸烟外，还有其他原因导致筛查试验无反应，但是同样按照戒烟干预试验推荐的，采用意向性治疗(ITT)分析所获得的数据。
结果：约17%（16.6%）的参与者戒烟，高于普通成人人群（3～7%）。然而，与不筛查组相比（19.1%），筛查与较低的持续戒断率（14.5%）有关（OR 1.40, 95% CI：1.01 ～1.92; p<0.05）。ITT分析未显示出统计学差异。
结论：与一般人群相比，所有试验参与者倾向于戒烟，这表明肺癌筛查是一个改善吸烟行为的教育时机。在进行筛查的吸烟者中，戒断率显著低于对照组，虽然该差异并不很大。ITT分析未见存在该差异。
（林江涛 审校）
Thorax. 2010 Jul;65(7):600-605.
Lung cancer screening and smoking abstinence: 2 year follow-up data from the Dutch-Belgian randomised controlled lung cancer screening trial
van der Aalst CM, van den Bergh KA, Willemsen MC, de Koning HJ, van Klaveren RJ.
Department of Public Health/Pulmonology, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands. c.vanderaalst@erasmusmc.nl.
Abstract
Background Lung cancer screening may provide a new opportunity for attempts to quit among smokers or might delay smoking cessation, but studies to date failed to provide evidence for this. This study investigated the effect of lung cancer screening on smoking abstinence in male smokers participating in the Dutch-Belgian randomised controlled lung cancer screening trial (NELSON trial).
Methods In the NELSON trial, 50- to 75-year-old participants at high risk for developing lung cancer were randomised to either lung cancer screening or no screening. Smoking behaviour was evaluated in two random samples of male smokers in the screen (n=641) and control arm (n=643) before (T0) and 2 years after randomisation (T1). In addition, the data were also analysed by intention-to-treat (ITT) analysis, as recommended in smoking cessation intervention trials, although non-response in screening trials can also be due to reasons other than continued smoking.
Results Almost 17% (16.6%) of the trial participants quit smoking, which is higher than the 3-7% found in the general adult population. However, screening was associated with a lower prolonged abstinence rate (14.5%) compared with no screening (19.1%) (OR 1.40, 95% CI 1.01 to 1.92; p<0.05). No stastistically significant difference was found after performing an ITT analysis.
Conclusions This study showed that all trial participants were inclined to stop smoking more than average, which suggests that screening is a teachable moment to improve smoking behaviour. In those who underwent screening the smoking abstinence rate was significantly lower than for the control group, although the difference was modest. After ITT analysis this difference was no longer observed. Clinical trial number ISRCTN63545820.
Thorax. 2010 Jul;65(7):600-5.
背景：肺癌筛查可能为吸烟者戒烟提供一个新的机会，或者可能延迟戒烟。但目前尚未有研究提供相关证据。本试验在参与荷兰-比利时肺癌筛查随机对照试验（NELSON）的男性吸烟者中，研究肺癌筛查对戒烟的影响。
方法：在NELSON 研究中，参与者年龄为50～75岁，有罹患肺癌的高风险。对该研究中男性吸烟者的两个随机样本进行研究：筛查组（n=641）和对照组（n=643）。在研究开始前和随机分组后2年(T1)，评价其吸烟行为。虽然除了持续吸烟外，还有其他原因导致筛查试验无反应，但是同样按照戒烟干预试验推荐的，采用意向性治疗(ITT)分析所获得的数据。
结果：约17%（16.6%）的参与者戒烟，高于普通成人人群（3～7%）。然而，与不筛查组相比（19.1%），筛查与较低的持续戒断率（14.5%）有关（OR 1.40, 95% CI：1.01 ～1.92; p<0.05）。ITT分析未显示出统计学差异。
结论：与一般人群相比，所有试验参与者倾向于戒烟，这表明肺癌筛查是一个改善吸烟行为的教育时机。在进行筛查的吸烟者中，戒断率显著低于对照组，虽然该差异并不很大。ITT分析未见存在该差异。
（林江涛 审校）
Thorax. 2010 Jul;65(7):600-605.
Lung cancer screening and smoking abstinence: 2 year follow-up data from the Dutch-Belgian randomised controlled lung cancer screening trial
van der Aalst CM, van den Bergh KA, Willemsen MC, de Koning HJ, van Klaveren RJ.
Department of Public Health/Pulmonology, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands. c.vanderaalst@erasmusmc.nl.
Abstract
Background Lung cancer screening may provide a new opportunity for attempts to quit among smokers or might delay smoking cessation, but studies to date failed to provide evidence for this. This study investigated the effect of lung cancer screening on smoking abstinence in male smokers participating in the Dutch-Belgian randomised controlled lung cancer screening trial (NELSON trial).
Methods In the NELSON trial, 50- to 75-year-old participants at high risk for developing lung cancer were randomised to either lung cancer screening or no screening. Smoking behaviour was evaluated in two random samples of male smokers in the screen (n=641) and control arm (n=643) before (T0) and 2 years after randomisation (T1). In addition, the data were also analysed by intention-to-treat (ITT) analysis, as recommended in smoking cessation intervention trials, although non-response in screening trials can also be due to reasons other than continued smoking.
Results Almost 17% (16.6%) of the trial participants quit smoking, which is higher than the 3-7% found in the general adult population. However, screening was associated with a lower prolonged abstinence rate (14.5%) compared with no screening (19.1%) (OR 1.40, 95% CI 1.01 to 1.92; p<0.05). No stastistically significant difference was found after performing an ITT analysis.
Conclusions This study showed that all trial participants were inclined to stop smoking more than average, which suggests that screening is a teachable moment to improve smoking behaviour. In those who underwent screening the smoking abstinence rate was significantly lower than for the control group, although the difference was modest. After ITT analysis this difference was no longer observed. Clinical trial number ISRCTN63545820.
Thorax. 2010 Jul;65(7):600-5.
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