OBJECTIVE Non-calcified nodules (NCNs) associated with false positive low-dose CT (LDCT) lung cancer screens have been attributed to various causes. Some, however, may represent lung cancer precursors. An association of NCNs with long-term lung cancer risk would provide indirect evidence of some NCNs being cancer precursors. METHODS LDCT arm participants in the National Lung Screening Trial (NLST) received LDCT screens at baseline and years 1-2. The relationship between NCNs found on LDCT screens and subsequent lung cancer diagnosis over different time periods was examined at the person and lobe level. For the latter, a lobe had a cancer outcome only if the cancer was located in the lobe. Separate analyses were performed on baseline and post-baseline LDCT findings; for the latter, those with baseline NCNs were excluded and only new (non-pre-existing) NCNs examined. Raw and adjusted rate-ratios (RRs) were computed for presence of NCNs and subsequent lung cancer risk; adjusted RRs controlled for demographic and smoking factors. RESULTS 26,309 participants received the baseline LDCT screen. Over median 11.3 years follow-up, 1675 lung cancers were diagnosed. Adjusted RRs for time periods 0-4, 4-8 and 8-12 years following the baseline screen were 5.1 (95 % CI:4.4-5.9), 1.5 (95 % CI:1.3-1.9) and 1.5 (95 % CI:1.2-1.8) at the person-level and 14.7 (95 % CI:12.6-17.2), 2.6 (95 % CI: 2.0-3.4) and 2.2 (95 % CI:1.6-2.9) at the lobe-level. 18,585 participants were included in the post-baseline analysis. Adjusted RRs for periods 0-4, 4-8 and 8-11 years were 5.6 (95 % CI: 4.5-7.0), 1.9 (95 % CI: 1.3-2.7) and 1.6 (95 % CI: 0.9-2.9) at the person-level and 19.6 (95 % CI:14.9-25.3), 2.5 (95 % CI:1.3-4.7) and 3.3 (95 % CI:1.4-7.6) at the lobe-level. Raw RRs were similar. CONCLUSION NCNs are associated with excess long-term lung cancer risk, suggesting that some may be lung cancer precursors.

中文翻译：

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在低剂量筛查CT扫描中观察到与肺结节相关的长期癌症风险。

目的与假阳性低剂量CT（LDCT）肺癌筛查相关的非钙化结节（NCN）已归因于多种原因。但是，有些可能代表肺癌的前体。NCN与长期肺癌风险的关联将提供某些NCN是癌症前体的间接证据。方法参加国家肺部筛查试验（NLST）的LDCT手臂参与者在基线和1-2岁时接受了LDCT筛查。在人和肺叶水平上检查了LDCT筛查上发现的NCN与随后不同时期的肺癌诊断之间的关系。对于后者，仅当癌症位于叶中时，叶才有癌症结果。对基线和基线后LDCT结果进行了单独的分析；对于后者，具有基线NCN的患者被排除在外，仅检查新的（不存在的）NCN。计算NCN的存在和随后的肺癌风险的原始比率和调整比率-比率（RRs）；根据人口和吸烟因素对调整后的RR进行控制。结果26,309名参与者接受了LDCT基线筛查。在中位11.3年的随访中，共诊断出1675例肺癌。基线筛查后0-4、4-8和8-12年的调整后RR为5.1（95％CI：4.4-5.9），1.5（95％CI：1.3-1.9）和1.5（95％CI：在人员级别上为1.2-1.8），在瓣级别上为14.7（95％CI：1.2-6-17.2），2.6（95％CI：2.0-3.4）和2.2（95％CI：1.6-2.9）。基线后分析包括18,585名参与者。0-4、4-8和8-11年的调整后RR为5.6（95％CI：4.5-7.0），1.9（95％CI：1.3-2.7）和1.6（95％CI：0.9-2）。在人员级别上为9），在瓣级别上为19.6（95％CI：14.9-25.3），2.5（95％CI：1.3-4.7）和3.3（95％CI：1.4-7.6）。原始RR相似。结论NCNs与过度的长期肺癌风险相关，表明某些可能是肺癌的前体。