BACKGROUND There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. METHODS A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. RESULTS Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. CONCLUSIONS In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).

中文翻译：

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在随机试验中通过容积 CT 筛查降低肺癌死亡率。

背景 随机试验中关于基于容积的低剂量计算机断层扫描 (CT) 筛查是否可以降低前吸烟者和现在吸烟者的肺癌死亡率的随机试验数据有限。方法 共有 13,195 名年龄在 50 至 74 岁之间的男性（主要分析）和 2594 名女性（亚组分析）被随机分配在 T0（基线）、第 1 年、第 3 年和第 5.5 年接受 CT 筛查或不进行筛查。我们通过与荷兰和比利时的国家登记处的联系获得了有关癌症诊断以及死亡日期和原因的数据，并且审查委员会在可能的情况下确认了肺癌为死亡原因。对所有参与者完成了至少 10 年的随访，直至 2015 年 12 月 31 日。结果 在男性中，CT 筛查的平均依从性为 90.0%。平均，9。2% 的筛选参与者接受了至少一次额外的 CT 扫描（最初不确定）。可疑结节的总体转诊率为 2.1%。随访10年，筛查组肺癌发生率为5.58例/1000人年，对照组为4.91例/1000人年；肺癌死亡率分别为每 1000 人年 2.50 人死亡和每 1000 人年 3.30 人死亡。与对照组相比，筛查组 10 年肺癌死亡率的累积率为 0.76（95% 置信区间 [CI]，0.61 至 0.94；P = 0.01），与第 8 年和第 8 年的值相似9. 在女性中，随访 10 年的比率为 0.67（95% CI，0.38 至 1.14），第 7 年至第 9 年的比率为 0.41 至 0.52。结论 在这项涉及高危人群的试验中，接受容积 CT 筛查的患者的肺癌死亡率显着低于未接受筛查的患者。提示肺癌的结果的后续程序率很低。（由荷兰卫生研究与发展组织和其他机构资助；NELSON 荷兰试验注册号，NL580。）。