低剂量 CT 筛查检出的日本不吸烟肺癌病例的 CT 筛查效果分析
Efficacy of CT screening for lung cancer in never-smokers: analysis of Japanese cases detected using a low-dose CT screen.
机构信息
Respiratory Center, Shinshu University Hospital, Matsumoto, Japan.
出版信息
Lung Cancer. 2011 Dec;74(3):426-32. doi: 10.1016/j.lungcan.2011.05.006. Epub 2011 Jun 12.
CT-screening for lung cancer is fairly widely used for both smokers and never-smokers in East Asia because the mortality rate for never-smokers due to this cancer is relatively high in this region. We performed comparative analyses, as a retrospective study, on three lung cancer arms detected by CT-screen, X-ray-screen, and via analysis of clinicopathological features and outcomes in never-smokers from a symptomatic-prompted group of patients. The total study cohort comprised 218 patients in CT group, 160 in X-ray group, and 82 in symptomatic-prompted group. The percentage of bronchioloalveolar carcinoma (BAC) was 65.1% in CT-screen group. The ratio of stage IA tumors in CT-screen group was 88.5% and the ratio of advanced cases (i.e. stages IIIB+IV) was 2.3%. The 5-year-survival rates were 95.0% in CT-screen, 73.0% in X-ray-screen and 40.0% in symptomatic-prompted group. We performed further sub-analysis which excluded pure BACs (i.e. Noguchi types A and B) or pure GGOs within a 10mm diameter because this is indicative of a very favorable prognosis. Based on this sub-analysis the number of the subjects in each group became 76 in CT group; 140 in X-ray group and 77 in symptomatic-prompted group. The principal characteristics of the patients such as age and sex became almost even in the three arms. In CT-screen subgroup, the ratio of stage IA cancer was 69.7% and of advanced cases was 6.6%. This advanced ratio was lower than both X-ray-screen (22.1%) and symptomatic-prompted (61.9%) groups. The 5-year-survival rates were 89.9% among CT-screen group patients, 72.6% for X-ray screen cases and 39.1% in symptomatic-prompted group. A CT-screen was found to be one of the independent prognostic factors for lung cancer (HR, 0.28; 95% CI, 0.12-0.72) and based on this would be expected to reduce the risk of lung cancer death by 78% compared with non-screened cases. In conclusion, CT will improve the survival rate and decrease the rate of advanced cancers in never-smokers via the existing annual screening system. CT-screening is also an independent prognostic improvement factor in never-smokers, and will therefore reduce the risk of lung cancer death.
在东亚地区，由于该地区不吸烟人群的肺癌死亡率相对较高，因此对不吸烟人群也相当广泛地采用 CT 筛查肺癌。我们进行了回顾性研究的比较分析，在一组有症状的患者中，通过 CT 筛查、X 射线筛查以及分析临床病理特征和结果检测到三组肺癌，对不吸烟人群进行了分析。总研究队列包括 CT 组 218 例、X 射线组 160 例和有症状组 82 例。CT 筛查组中细支气管肺泡癌（BAC）的比例为 65.1%。CT 筛查组 IA 期肿瘤的比例为 88.5%，晚期病例（即 IIIB+IV 期）的比例为 2.3%。CT 筛查组的 5 年生存率为 95.0%，X 射线组为 73.0%，有症状组为 40.0%。我们进一步进行了亚组分析，排除了纯 BAC（即 Noguchi 类型 A 和 B）或 10mm 直径内的纯磨玻璃影（GGO），因为这预示着非常有利的预后。基于此亚组分析，每组的受试者数量变为 CT 组 76 例，X 射线组 140 例，有症状组 77 例。三组患者的主要特征，如年龄和性别，几乎相同。在 CT 筛查亚组中，IA 期癌症的比例为 69.7%，晚期病例的比例为 6.6%。这个晚期比例低于 X 射线筛查（22.1%）和有症状组（61.9%）。CT 筛查组的 5 年生存率为 89.9%，X 射线组为 72.6%，有症状组为 39.1%。CT 筛查被发现是肺癌的独立预后因素之一（HR，0.28；95%CI，0.12-0.72），与非筛查病例相比，预计可将肺癌死亡风险降低 78%。总之，通过现有的年度筛查系统，CT 筛查将提高不吸烟人群的生存率并降低晚期癌症的比例。CT 筛查也是不吸烟人群的独立预后改善因素，因此将降低肺癌死亡风险。
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