西安地区肺癌高危人群低剂量螺旋CT筛查结果分析

doi:10.12183/j.scjpm.2023.1463

摘要/Abstract

摘要： 目的分析肺癌高危人群低剂量螺旋CT（LDCT）筛查结果,并探讨影响肺阳性结节的危险因素。方法于2022年6—12月现场招募参与“城市癌症早诊早治项目”的西安市社区居民筛选肺癌高危人群,对肺癌高危人群进行LDCT筛查以及人群特征情况调查,并利用logistic模型对肺阳性结节率的相关影响因素进行多因素分析。结果最终招募2 786例肺癌高危人群进行LDCT筛查。其中男1 672例（60.01%）,女性1 114例（39.99%）;年龄50~75岁,中位年龄59岁。筛查出327例肺阳性结节,肺阳性结节率为11.74%。其中,实性结节174例（53.21%）、部分实性结节97例（29.66%）、非实性结节（纯磨玻璃影）56例（17.13%）。二分类logistic模型中进行多因素分析,结果显示年龄（OR=1.510）、文化程度（OR=1.358）、吸烟指数≥400（OR=2.356）、家族肺癌史（OR=3.804）、精神抑郁状态（OR=2.951）、经常体育锻炼（OR=0.470）是影响其LDCT筛查阳性的独立影响因素。结论 LDCT筛查应用在肺癌高危人群中有助于提升肺结节阳性以及肺癌检出率,对高龄、低学历、吸烟程度高、缺乏锻炼以及具有肺癌家族史和精神抑郁的肺癌高危人群的LDCT筛查应该引起高度关注。

关键词: 肺癌高危人群, 低剂量螺旋CT, 筛查, 肺结节, 影响因素

中图分类号:

R195

刘阳, 高杨, 王维花, 南菁, 孟金龙, 乔亚. 西安地区肺癌高危人群低剂量螺旋CT筛查结果分析[J]. 华南预防医学, 2023, 49(11): 1463-1467.

参考文献

[1] Cao W, Chen HD, Yu YW, et al.Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021, 134(7):783-791.
[2] Lempainen L, Kosola J, Valle X, et al.Chronic and recurrent rectus femoris central tendon ruptures in athletes: Clinical picture, mri findings, and results of surgical treatment[J]. Orthop J Sports Med, 2021, 9(2):2325967120984486.
[3] Duma N, Santana‐Davila R, Molina JR. Non‐small cell lung cancer: Epidemiology, screening, diagnosis, and treatment[J]. Mayo Clin Proc, 2019, 94(8):1623-1640.
[4] Alexander M, Kim SY, Cheng H.Update 2020: Management of non‐small cell lung cancer[J]. Lung, 2020, 198(6):897-907.
[5] Sun D, Li H, Cao M, et al.Cancer burden in China: Trends, risk factors and prevention[J]. Cancer Biol Med, 2020, 17(4):879-895.
[6] 孙良璋, 李建忠, 张丹杰, 等. 低剂量螺旋CT联合7种肺癌自身抗体检测对早期肺癌的筛查价值[J]. 癌症进展, 2021, 19(4):345-348.
[7] Tringali G, Milanese G, Ledda RE, et al.Lung cancer screening: Evidence, risks, and opportunities for implementation[J]. Rofo, 2021, 193(10):1153-1161.
[8] de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung‐cancer mortality with volume ct screening in a randomized trial[J]. N Engl J Med, 2020, 382(6):503-513.
[9] Fan L, Liu SY.Lung cancer screening using low dose CT: Screening population and positive results definition[J]. J Thorac Dis, 2015, 7:E338-E340.
[10] Liu HY, Zhao XR, Chi M, et al.Risk assessment of malignancy in solitary pulmonary nodules in lung computed tomography: A multivariable predictive model study[J]. Chin Med J (Engl), 2021, 134(14):1687-1694.
[11] 中华医学会放射学分会心胸学组. 低剂量螺旋CT肺癌筛查专家共识[J]. 中华放射学杂志, 2015(5):328-335.
[12] 段泉泉, 胜利. 焦虑及抑郁自评量表的临床效度[J]. 中国心理卫生杂志, 2012, 26(9):676-679.
[13] 赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021,北京)[J]. 中华肿瘤杂志, 2021, 43(3):243-268.
[14] Snowsill T, Yang H, Griffin E, et al.Low‐dose computed tomography for lung cancer screening in high‐risk populations:A systematic review and economic evaluation[J]. Health Technol Assess, 2018, 22(69):1-276.
[15] Paci E.The narrow path to organized LDCT lung cancer screening programs in Europe[J]. J Thorac Dis, 2018, 10(7):4556-4564.
[16] Oudkerk M, Devaraj A, Vliegenthart R, et al.European position statement on lung cancer screening[J]. Lancet Oncol, 2017, 18(12):e754-e766.
[17] 中华医学会呼吸病学分会肺癌学组,中国肺癌防治联盟专家组. 肺结节诊治中国专家共识(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(10):763-771.
[18] Oudkerk M, Devaraj A, Vliegenthart R, et al.European position statement on lung cancer screening[J]. Lancet Oncol, 2017, 18(12):e754-e766.
[19] Thawani R, McLane M, Beig N, et al. Radiomics and radiogenomics in lung cancer: A review for the clinician[J]. Lung Cancer, 2018, 115:34-41.
[20] Heuvelmans MA, Walter JE, Vliegenthart R, et al.Disagreement of diameter and volume measurements for pulmonary nodule size estimation in CT lung cancer screening[J]. Thorax, 2018, 73(8):779-781.
[21] 任剑, 王晓波, 舒虹, 等. 2018—2019年南昌市社区肺癌高危人群筛查结果及危险因素分析[J]. 中华肿瘤杂志, 2021, 43(12):1316-1321.
[22] 魏新萍, 马学东, 江威, 等. 社区肺癌高危人群低剂量螺旋CT筛查结果分析[J]. 上海医药, 2018, 39(2):47-49,62.
[23] 蔡兰平, 张芬, 李为希, 等. 莘庄社区肺癌高危人群低剂量螺旋CT筛查结果分析[J]. 中国慢性病预防与控制, 2020, 28(6):479-480,封3.
[24] Oliver AL.Lung Cancer: Epidemiology and Screening[J]. Surg Clin North Am, 2022, 102(3):335-344.
[25] Marcus JZ, Cason P, Downs LS Jr, et al.The ASCCP cervical cancer screening task force endorsement and opinion on the American cancer society updated cervical cancer screening guidelines[J]. J Low Genit Tract Dis, 2021, 25(3):187-191.
[26] Fan L, Wang Y, Zhou Y, et al.Lung cancer screening with low‐dose CT: Baseline screening results in shanghai[J]. Acad Radiol, 2019, 26(10):1283-1291.
[27] 张耀森,卢国杰,钟惠铃,等.广州地区肺癌高危人群筛查依从性及筛查结果分析[J].华南预防医学,2022,48(12):1455-1459.
[28] Tse LA, Yu IT, Rothman N, et al.Joint effects of environmental exposures and familial susceptibility to lung cancer in Chinese never smoking men and women[J]. J Thorac Oncol, 2014, 9(8):1066-1072.
[29] Yang W, Qian F, Teng J, et al.Community‐based lung cancer screening with low‐dose CT in China: Results of the baseline screening[J]. Lung Cancer, 2018, 117:20-26.
[30] 王伟红, 曹旸, 王晓翠, 等. 郑州市肺癌早期筛查检出肺结节临床特征及影响因素分析[J]. 中华肿瘤防治杂志, 2022, 29(7):468-474.