Oken Martin M, Marcus Pamela M, Hu Ping, Beck Thomas M, Hocking William, Kvale Paul A, Cordes Jill, Riley Thomas L, Winslow Stephen D, Peace Steven, Levin David L, Prorok Philip C, Gohagan John K
Hubert H. Humphrey Cancer Center, North Memorial Medical Center, Robbinsdale, MN 55422, USA.
J Natl Cancer Inst. 2005 Dec 21;97(24):1832-9. doi: 10.1093/jnci/dji430.
The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial was initiated in 1992 to examine cause-specific mortality reduction from screening for these four cancers in men and women. We report lung cancer detection results of the baseline screening round.
Of the 154,942 participants enrolled, who were aged 55-74 years with no history of PLCO cancers, 77,465 were randomly assigned to the intervention arm. Current or former smokers and never smokers in this arm received an initial single-view posterior-anterior chest radiograph.
In the initial screen, 5991 (8.9%, 95% confidence interval [CI] = 8.7% to 9.2%) of radiographs were suspicious for lung cancer: 8.2% (95% CI = 7.9% to 8.5%) for women and 9.6% (95% CI = 9.3% to 10.0%) for men. Rates were highest for older age groups and for smokers. Among those 5991 participants with a positive screen, 206 (3.4%, 95% CI = 3.0% to 3.9%) underwent biopsy examination, 126 (61.2%, 95% CI = 54.5% to 67.8%) of whom were diagnosed with lung cancer within 12 months of the screen (59 in women and 67 in men). The positive predictive value was 2.1% (95% CI = 1.7% to 2.5%), and 1.9 lung cancers were detected per 1000 screens. Among these cancers, 44% (95% CI = 35% to 52%) were stage I non-small-cell lung cancer. High rates of lung cancer were found in current smokers (6.3 per 1000 screens) and in former smokers who had smoked within the past 15 years (4.9 per 1000 screens). The lung cancer detection rate among never smokers was 0.4 per 1000 screens; this group accounted for 11% (95% CI = 5.6% to 16.6%) of the cancers identified.
In the baseline screen, nearly half the cancers were stage I. Whether this experience results in a reduction in lung cancer mortality is yet to be seen.
前列腺、肺、结肠直肠和卵巢（PLCO）癌筛查试验于1992年启动，旨在研究通过筛查降低这些癌症在男性和女性中的特定病因死亡率。我们报告基线筛查轮次的肺癌检测结果。
在154,942名年龄在55 - 74岁且无PLCO癌症病史的参与者中，77,465人被随机分配到干预组。该组中的现吸烟者、曾经吸烟者和从不吸烟者均接受了首次后前位胸部单视图X线胸片检查。
在初次筛查中，5991份（8.9%，95%置信区间[CI]=8.7%至9.2%）X线胸片显示肺癌可疑：女性为8.2%（95%CI = 7.9%至8.5%），男性为9.6%（95%CI = 9.3%至10.0%）。年龄较大的组和吸烟者的检出率最高。在这5991名筛查呈阳性的参与者中，206人（3.4%，95%CI = 3.0%至3.9%）接受了活检检查，其中126人（61.2%，95%CI = 54.5%至67.8%）在筛查后12个月内被诊断为肺癌（女性59人，男性67人）。阳性预测值为2.1%（95%CI = 1.7%至2.5%），每1000次筛查中检测到1.9例肺癌。在这些癌症中，44%（95%CI = 35%至52%）为I期非小细胞肺癌。现吸烟者（每1000次筛查中有6.3例）和过去15年内吸烟的曾经吸烟者（每1000次筛查中有4.9例）的肺癌检出率较高。从不吸烟者中的肺癌检出率为每1000次筛查0.4例；该组占确诊癌症的11%（95%CI = 5.6%至16.6%）。
在基线筛查中，近一半的癌症为I期。这种情况是否会降低肺癌死亡率还有待观察。
