国家癌症中心/中国医学科学院:单次LDCT筛查即可降低1/3肺癌死亡风险!

2022-03-12 MedSci原创 MedSci原创

在我国的医疗环境下,一次性LDCT筛查与肺癌死亡率和全因死亡率的显著降低有关。

当今,肺癌是恶性肿瘤相关死亡的重要原因之一。根据GLOBOCAN 2020的预估,全球大约有1930万的新发病例和990万因癌症死亡的病例。肺癌是第二常见的癌症,也是导致癌症死亡的主要原因,预计2020年约有220万肺癌新发病例和180万肺癌死亡病例。在2020年的全球肺癌新发病例中,约有37%来自中国。而在因肺癌死亡的病例中,中国病例约占其中的39.8%。

尽管近年来肺癌治疗手段有较快发展,然而总体预后并无明显改善,目前5年总生存率仅为16%-18%。究其原因是缺乏有效的早期诊断方法,肺癌确诊时70%-80%均为中晚期。Ⅰ期肺癌5年存活率达60%-70%,而Ⅳ期肺癌存活率不到5%。因此肺癌的早期筛查诊断是减少其死亡率及延长生存率的关键因素。

为了评估一次性低剂量CT(LDCT)筛查在中国早期发现肺癌的有效性,来自国家癌症中心/中国医学科学院肿瘤医院的专家在中国8个省的12个城市进行了一项多中心、基于人群的前瞻性队列研究,结果发表在Lancet Respiratory Medicine杂志上。

研究人员招募了40-74岁无肺癌症状和无肺癌病史的人。参与者被划分为肺癌高风险或低风险,使用的是针对不同性别的风险评分,包括吸烟、身体活动水平、职业暴露、慢性呼吸道疾病史、肺癌家族史、饮食和被动吸烟(仅女性)。高风险的参与者被邀请进行一次性的LDCT扫描,并根据他们是否进行扫描而被分为筛查组和非筛查组。计算了筛查组和非筛查组的肺癌发病密度、肺癌死亡率和全因死亡率。

在2013年2月19日至2018年10月31日期间,1016740名参与者被纳入研究,其中3581人在中位随访3.6年(IQR 2.8-5.1)后被诊断为肺癌。在223302名高风险参与者中,79581人(35.6%)进行了LDCT扫描(筛查组),143721人(64.4%)没有(非筛查组)。

在反概率加权后,与非筛查组的参与者相比,筛查组的肺癌发病率虽然高47.0%(HR=1.47[95% CI 1.27-1.70]),但死亡率降低31.0%(HR=0.69[95% CI 0.53-0.92]),全因死亡率低32.0%(HR=0.68[0.57-0.82])。

综上,在我国的医疗环境下,一次性LDCT筛查与肺癌死亡率和全因死亡率的显著降低有关。

 

参考文献:

One-off low-dose CTfor lung cancer screening in China: a multicentre, population-based,prospective cohort study. The Lancet Respiratory Medicine, DOI:https://doi.org/10.1016/S2213-2600(21)00560-9

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    2022-11-19 weiz
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    2022-03-13 萌宝嘟嘟

    好东西,谢谢分享

    0

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