CT-Screening beim Lungenkarzinom – wie ist die Evidenz?

Was ist neu?

Effektivität des CT-Screenings Die amerikanische NLST-Studie hat erste wichtige Erkenntnisse über die Senkung der Lungenkrebsletalität mittels CT-Screening geliefert. Kritikpunkte dieser Studie sind die hohen Raten an falsch positiven Befunden und Überdiagnosen sowie die relativ kurze Nachbeobachtungszeit. Vorläufige Ergebnisse europäischer Studien konnten die Senkung der Letalität der NLST-Studie nicht bestätigen. Das CT-Screening ist in Deutschland nicht als Früherkennungsuntersuchung zugelassen.

Aktueller Status der Biomarker-Entwicklung zur Früherkennung des Lungenkarzinoms Innovative Verfahren zur Ergänzung des CT-Screenings sind momentan Gegenstand der Forschung. Hierzu zählen Blutuntersuchungen, die sogenannten Liquid Biopsies, sowie die Analyse von Atemgas-Kondensaten. Die Analyse von Blutproben erlaubt die Detektion molekularer Veränderungen. Mithilfe von Atemtests sind sogar minimale Veränderungen in der Zusammensetzung des Atemgases messbar, sodass mithilfe dieser Methode Lungenkarzinome bereits im Frühstadium erkannt werden können. Beide Verfahren könnten in Zukunft unter Umständen einen Tumor zeitlich vor der Bildgebung erkennen und würden somit die herkömmlichen bildgebenden Verfahren ergänzen. Ein weiteres Einsatzgebiet beider Methoden wäre die Identifizierung falsch positiver Lungenkrebsbefunde.

Abstract

In patients with lung cancer treatment opportunities and prognosis are correlated to the stage of disease with a chance for curative treatment in patients with early stage disease. Therefore, early detection of lung cancer is of paramount importance for improving the prognosis of lung cancer patients.

The National Lung Screening Trial (NLST) has already shown that low-dose CT increases the number of identified early stage lung cancer patients and reduces lung cancer related mortality. Critically considered in terms of CT-screening are false-positive results, overdiagnosis and unessential invasive clarification. Preliminary results of relatively small European trials haven´t yet confirmed the results of the NLST-study.

Until now Lung Cancer Screening by low dose CT-scan or other methods is neither approved nor available in Germany.

To improve the efficacy of CT-Screening and to introduce early detection of lung cancer in standard practice, additional, complementing methods should be further evaluated. One option might be the supplementary analysis of biomarkers in liquid biopsies or exhaled breath condensates. In addition, defining the high-risk population is of great relevance to identify candidates who might benefit of early detection programs.

Schlüsselwörter

Lungenkarzinom - Früherkennung - Screening - CT

Key words

lung cancer - early detection - screening - CT

• Literatur

• 1 Goldstraw P, Chansky K, Crowley J. et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11: 39-51
• 2 Fontana RS, Sanderson DR, Woolner LB. et al. Lung cancer screening: the Mayo program. J Occup Med 1986; 28: 746-750
• 3 Schmidt C. Lung cancer screening poised to expand. J Natl Cancer Inst 2015; 107 DOI: 10.1093/jnci/djv114.
• 4 Becker N, Motsch E, Gross ML. et al. Randomized Study on Early Detection of Lung Cancer with MSCT in Germany: Results of the First 3 Years of Follow-up After Randomization. J Thorac Oncol 2015; 10: 890-896
• 5 Field JK, Duffy SW, Baldwin DR. et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2016; 71: 161-170
• 6 Horeweg N, Scholten ET, de Jong PA. et al. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol 2014; 15: 1342-1350
• 7 Infante M, Cavuto S, Lutman FR. et al. Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. Am J Respir Crit Care Med 2015; 191: 1166-1175
• 8 Paci E, Puliti D, Lopes Pegna A. et al. Mortality, survival and incidence rates in the ITALUNG randomised lung cancer screening trial. Thorax 2017; 72: 825-831
• 9 Pastorino U, Rossi M, Rosato V. et al. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev 2012; 21: 308-315
• 10 Wille MM, Dirksen A, Ashraf H. et al. Results of the Randomized Danish Lung Cancer Screening Trial with Focus on High-Risk Profiling. Am J Respir Crit Care Med 2016; 193: 542-551
• 11 Aberle DR, Adams AM. National Lung Screening Trial Research T. et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409
• 12 MacMahon H, Naidich DP, Goo JM. et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017; 284: 228-243
• 13 Bach PB, Mirkin JN, Oliver TK. et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012; 307: 2418-2429
• 14 Schwarzenbach H, Hoon DS, Pantel K. Cell-free nucleic acids as biomarkers in cancer patients. Nat Rev Cancer 2011; 11: 426-437
• 15 Mehta A, Cordero J, Dobersch S. et al. Non-invasive lung cancer diagnosis by detection of GATA6 and NKX2-1 isoforms in exhaled breath condensate. EMBO Mol Med 2016; 8: 1380-1389