Lung Cancer Screening: An Overview of Systematic Reviews_Chinese Journal of Evidence-Based Medicine

Authors：

 LIJiang ¹ , SUKai ² , HUANGYao ³ , LIFang ² , TANGWei ³ , WANGLe ¹ , HUANGHui-yao ¹ ,  DAIMin ¹

1. Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
2. Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
3. Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;

Corresponding author：

DAIMin, Email: daimin2002@hotmail.com

Keywords：

Lung cancer; Screening; Overview of systematic reviews; Risk of bias; Quality of evidence

DOI：

10.7507/1672-2531.20160119

Video：

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Objective To evaluate the risk of bias and reliability of conclusions of systematic reviews (SRs) of lung cancer screening. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 2, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect SRs of lung cancer screening from inception to February 29^th, 2016. The ROBIS tool was applied to assess the risk of bias of included SRs, and then GRADE system was used for evidence quality assessment of outcomes of SRs. Results A total of 11 SRs involving 5 outcomes (mortality, detection rate, survival rate, over-diagnosis and potential benefits and harms) were included. The results of risk of bias assessment by ROBIS tool showed:Two studies completely matched the 4 questions of phase 1. In the phase 2, 6 studies were low risk of bias in the including criteria field; 8 studies were low risk of bias in the literature search and screening field; 3 studies were low risk of bias in the data abstraction and quality assessment field; and 5 studies were low risk of bias in the data synthesis field. In the phase 3 of comprehensive risk of bias results, 5 studies were low risk. The results of evidence quality assessment by GRADE system showed:three studies had A level evidence on the outcome of mortality; 1 study had A level evidence on detection; 1 study had A level evidence on survival rate; 3 studies on over-diagnosis had C level evidence; and 2 studies on potential benefits and harms had B level evidence. Conclusion The risk of bias of SRs of lung cancer screening is totally modest; however, the evidence quality of outcomes of these SRs is totally low. Clinicians should cautiously use these evidence to make decision based on local situation.

Citation： LIJiang, SUKai, HUANGYao, LIFang, TANGWei, WANGLe, HUANGHui-yao, DAIMin. Lung Cancer Screening: An Overview of Systematic Reviews. Chinese Journal of Evidence-Based Medicine, 2016, 16(7): 764-770. doi: 10.7507/1672-2531.20160119 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2):87-108.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2):115-132.
3.	Black WC, Gareen IF, Soneji SS, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med, 2014, 371(19):1793-1802.
4.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5):395-409.
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6.	Tammemägi MC, Katki HA, Hocking WG, et al. Selection Criteria for Lung-Cancer Screening. N Engl J Med, 2013, 368(8):728-736.
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14.	尚文丽, 张和平, 杨拴盈, 等. 低剂量螺旋CT对高危人群肺癌筛查价值的Meta分析. 西安交通大学学报(医学版), 2011, 32(1):38-42.
15.	惠珍珍. 低剂量CT与X线胸片对肺癌高危人群筛查的meta分析. 济南:山东大学, 2011.
16.	Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer:a systematic review. JAMA, 2012, 307(22):2418-2429.
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20.	Ollier M, Chamoux A, Naughton G, et al. Chest CT scan screening for lung cancer in asbestos occupational exposure:a systematic review and meta-analysis. Chest, 2014, 145(6):1339-1346.
21.	IOM (Institute of Medicine). Clinical Practice Guidelines We Can Trust. Washington, DC:The National Academies Press, 2011.
22.	陈耀龙, 杨克虎, 田金徽, 等. 循证实践指南的制定:国际经验与中国实践. 兰州大学学报(医学版), 2016, 42(1):29-35.
23.	杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 2011, 6(1):54-57.
24.	田金徽, 陈耀龙, 杨克虎, 等. SR/MA研究进展与挑战. 兰州大学学报(医学版), 2016, 42(1):42-46.
25.	熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR. 中国循证医学杂志, 2011, 11(9):1084-1089.
26.	吴琼芳, 丁泓帆, 邓围, 等. ROBIS:评估系统评价偏倚风险的新工具. 中国循证医学杂志, 2015, 15(12):1454-1457.
27.	丁泓帆, 吴琼芳, 杨楠, 等. 评估系统评价偏倚风险的ROBIS工具实例解读. 中国循证医学杂志, 2016, 16(1):115-121.
28.	Available at:http://www.crd.york.ac.uk/PROSPERO.
29.	Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines:3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4):401-406.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2):87-108.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2):115-132.
3. Black WC, Gareen IF, Soneji SS, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med, 2014, 371(19):1793-1802.
4. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5):395-409.
5. 袁金秋, 刘雅莉, 杨克虎, 等. 系统评价再评价纳入研究的质量评价方法调查. 中国循证医学杂志, 2012, 12(2):238-242.
6. Tammemägi MC, Katki HA, Hocking WG, et al. Selection Criteria for Lung-Cancer Screening. N Engl J Med, 2013, 368(8):728-736.
7. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer:U.S. Preventive Services Task Force recommendation statement. Ann Intern Med, 2014, 160(5):330-338.
8. Whiting P, Savović J, Higgins JP, et al. ROBIS group, ROBIS:A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69:225-234.
9. Guyatt GH, Oxman AD, Vist GE, et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650):924-926.
10. Manser RL, Irving LB, Byrnes G, et al. Screening for lung cancer:a systematic review and meta-analysis of controlled trials. Thorax, 2003, 58(9):784-789.
11. Yau G, Lock M, Rodrigues G. Systematic review of baseline low-dose CT lung cancer screening. Lung Cancer, 2007, 58(2):161-170.
12. Black C, de Verteuil R, Walker S, et al. Population screening for lung cancer using computed tomography, is there evidence of clinical effectiveness? A systematic review of the literature. Thorax, 2007, 62(2):131-138.
13. Gopal M, Abdullah SE, Grady JJ, et al. Screening for lung cancer with low-dose computed tomography:a systematic review and meta-analysis of the baseline findings of randomized controlled trials. J Thorac Oncol, 2010, 5(8):1233-1239.
14. 尚文丽, 张和平, 杨拴盈, 等. 低剂量螺旋CT对高危人群肺癌筛查价值的Meta分析. 西安交通大学学报(医学版), 2011, 32(1):38-42.
15. 惠珍珍. 低剂量CT与X线胸片对肺癌高危人群筛查的meta分析. 济南:山东大学, 2011.
16. Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer:a systematic review. JAMA, 2012, 307(22):2418-2429.
17. Chien CR, Liang JA, Chen JH, et al. Fluorodeoxyglucose-positron emission tomography screening for lung cancer:a systematic review and meta-analysis. Cancer Imaging, 2013, 13(4):458-465.
18. Manser R, Lethaby A, Irving LB, et al. Screening for lung cancer. Cochrane Database Syst Rev, 2013, 6:CD001991.
19. Humphrey L, Deffebach M, Pappas M, et al. Screening for Lung Cancer:Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Rockville (MD):Agency for Healthcare Research and Quality (US), 2013.
20. Ollier M, Chamoux A, Naughton G, et al. Chest CT scan screening for lung cancer in asbestos occupational exposure:a systematic review and meta-analysis. Chest, 2014, 145(6):1339-1346.
21. IOM (Institute of Medicine). Clinical Practice Guidelines We Can Trust. Washington, DC:The National Academies Press, 2011.
22. 陈耀龙, 杨克虎, 田金徽, 等. 循证实践指南的制定:国际经验与中国实践. 兰州大学学报(医学版), 2016, 42(1):29-35.
23. 杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 2011, 6(1):54-57.
24. 田金徽, 陈耀龙, 杨克虎, 等. SR/MA研究进展与挑战. 兰州大学学报(医学版), 2016, 42(1):42-46.
25. 熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR. 中国循证医学杂志, 2011, 11(9):1084-1089.
26. 吴琼芳, 丁泓帆, 邓围, 等. ROBIS:评估系统评价偏倚风险的新工具. 中国循证医学杂志, 2015, 15(12):1454-1457.
27. 丁泓帆, 吴琼芳, 杨楠, 等. 评估系统评价偏倚风险的ROBIS工具实例解读. 中国循证医学杂志, 2016, 16(1):115-121.
28. Available at:http://www.crd.york.ac.uk/PROSPERO.
29. Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines:3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4):401-406.

Chinese Journal of Evidence-Based Medicine

Lung Cancer Screening: An Overview of Systematic Reviews

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