Chien Chun-Ru, Lai Mei-Shu, Chen Tony Hsiu-Hsi
National Taiwan University Hospital, Taipei, Taiwan.
Lung Cancer. 2008 Nov;62(2):215-20. doi: 10.1016/j.lungcan.2008.02.020. Epub 2008 Apr 9.
Very few studies, particularly from oriental population, reported the progression of lung cancer from asymptomatic to symptomatic phase. The present study aimed to estimate mean sojourn time (MST) of lung cancer, an average duration period in which tumour can be asymptotically detected by chest X-ray (CXR), taking into account gender, smoking and histological type. Based on institutional cancer registry for lung cancer patients with prior non-diagnostic CXR (n=221), data were collected on demographic features, histology type, survival status, history of smoking, and asymptomatic or symptomatic status in light of chief complaint at diagnosis retrieved from medical records. The MST for the natural history of lung cancer underpinning a three-state Markov model was estimated with a Bayesian approach. The estimated MST for lung cancer was 5.51 months (95% credible interval: 4.04-7.12). Small cell lung carcinoma was even statistically significantly shorter MST than non-small cell lung carcinoma (3.01 (3-3.98) months vs. 6.07 (4.44-8.25) months). In parallel with literatures reporting tumour growth rate related to CXR and computed tomography (CT), the shorter mean sojourn time by using CXR estimated in our study strongly suggests that CT screening may be more effective in early detection of lung cancer in population-based screening.
极少有研究，尤其是来自东方人群的研究，报道过肺癌从无症状阶段发展到有症状阶段的情况。本研究旨在估算肺癌的平均停留时间（MST），即通过胸部X光（CXR）能够无症状检测到肿瘤的平均持续时间，并考虑性别、吸烟情况和组织学类型。基于机构癌症登记处中先前胸部X光检查未确诊的肺癌患者（n = 221）的数据，收集了人口统计学特征、组织学类型、生存状况、吸烟史以及根据从病历中检索到的诊断时的主要症状得出的无症状或有症状状态等数据。采用贝叶斯方法估计了支持三状态马尔可夫模型的肺癌自然史的平均停留时间。肺癌的估计平均停留时间为5.51个月（95%可信区间：4.04 - 7.12）。小细胞肺癌的平均停留时间在统计学上甚至显著短于非小细胞肺癌（3.01（3 - 3.98）个月对6.07（4.44 - 8.25）个月）。与报道肿瘤生长速度与胸部X光和计算机断层扫描（CT）相关的文献一致，我们研究中通过胸部X光估计的较短平均停留时间强烈表明，在基于人群的筛查中，CT筛查可能在肺癌早期检测方面更有效。
