van Klaveren R J, Habbema J D, de Koning H J, Oudkerk M, Damhuis R A, Hoogsteden H C
Academisch Ziekenhuis Rotterdam-Dijkzigt, afd. Longziekten, Dr. Molewaterplein 40, 3015 GD Rotterdam.
Ned Tijdschr Geneeskd. 2001 Mar 17;145(11):521-6.
The very poor prognosis of lung cancer has barely changed in the last two decades despite all efforts. However, prognosis is better when the disease is detected earlier, so that curative surgery or radiotherapy can be applied. Lung cancer screening in the past by chest X-ray did not lead to a decrease in lung cancer mortality, because the chest X-ray has low sensitivity for early invasive stages. With the advent of the low-dose spiral CT scan it has become feasible to detect early invasive stage I lung cancer in 80-90%. Modern screening for lung cancer by spiral CT scan could possibly decrease lung cancer mortality. Despite the first favourable results of screening the question remains whether lung cancer screening will be cost-effective. These questions can only be resolved in a randomised controlled trial with lung cancer mortality as unbiased end-point. Such a study should be initiated in the Netherlands, a country with large experience in screening trials and a good health care system. Only after lung cancer screening has proven to be cost-effective can appropriate implementation be recommended to prevent uncontrolled and opportunistic diffusion of this new screening technique into clinical practice in the near future.
尽管付出了种种努力，但在过去二十年里，肺癌的极差预后几乎没有改变。然而，如果疾病能更早被发现，预后会更好，这样就可以进行根治性手术或放疗。过去通过胸部X光进行肺癌筛查并未降低肺癌死亡率，因为胸部X光对早期浸润阶段的敏感性较低。随着低剂量螺旋CT扫描的出现，在80%-90%的患者中检测出早期浸润性I期肺癌已成为可能。通过螺旋CT扫描进行现代肺癌筛查可能会降低肺癌死亡率。尽管筛查取得了初步良好结果，但肺癌筛查是否具有成本效益仍是个问题。这些问题只能通过以肺癌死亡率为无偏倚终点的随机对照试验来解决。这样的研究应该在荷兰启动，该国在筛查试验方面经验丰富，医疗保健系统良好。只有在肺癌筛查被证明具有成本效益之后，才可以建议进行适当的实施，以防止这种新的筛查技术在不久的将来无节制地、随意地扩散到临床实践中。
