Cufari Maria Elena, Proli Chiara, De Sousa Paulo, Raubenheimer Hilgardt, Al Sahaf May, Chavan Hema, Shedden Lynn, Niwaz Zakiyah, Leung Maria, Nicholson Andrew G, Anikin Vladimir, Beddow Emma, McGonigle Niall, Dusmet Michael E, Jordan Simon, Ladas George, Lim Eric
Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, UK.
Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, UK.
Eur J Cancer. 2017 Oct;84:55-59. doi: 10.1016/j.ejca.2017.06.031. Epub 2017 Aug 4.
Never-smokers with lung cancer often present late as there are no established aetiological risk factors. The aim of the study is to define the frequency over time and characterise clinical features of never-smokers presenting sufficiently early to determine if it is possible to identify patients at risk.
We retrospectively analysed data from a prospectively collected database of patients who underwent surgery. The frequency was defined as number of never-smokers versus current and ex-smokers by year. Clinical features at presentation were collated as frequency.
A total of 2170 patients underwent resection for lung cancer from March 2008 to November 2014. The annual frequency of developing lung cancer in never-smokers increased from 13% to 28%, attributable to an absolute increase in numbers and not simply a change in the ratio of never-smokers to current and ex-smokers. A total of 436 (20%) patients were never-smokers. The mean age was 60 (16 SD) years and 67% were female. Presenting features were non-specific consisting of cough in 34%, chest infections in 18% and haemoptysis in 11%. A total of 14% were detected on incidental chest film, 30% on computed tomography, 7% on positron-emission tomography/computed tomography and 1% on MRI.
We observed more than a double of the annual frequency of never-smokers in the last 7 years. Patients present with non-specific symptoms and majority were detected on incidental imaging, a modality that is likely to play an increasingly important role for early detection in this cohort that does not have any observable clinical risk factors.
肺癌非吸烟者往往因缺乏已明确的病因风险因素而就诊较晚。本研究的目的是确定随时间推移的发病频率，并描述早期就诊的肺癌非吸烟者的临床特征，以判断是否有可能识别出有风险的患者。
我们回顾性分析了来自前瞻性收集的接受手术患者数据库的数据。发病频率按年份定义为肺癌非吸烟者与当前吸烟者及既往吸烟者的数量之比。将就诊时的临床特征整理为频率。
2008年3月至2014年11月，共有2170例患者接受了肺癌切除术。肺癌非吸烟者的年发病频率从13%增至28%，这是由于数量的绝对增加，而非仅仅是肺癌非吸烟者与当前吸烟者及既往吸烟者比例的变化。共有436例（20%）患者为肺癌非吸烟者。平均年龄为60（标准差16）岁，67%为女性。就诊特征不具特异性，34%表现为咳嗽，18%为胸部感染，11%为咯血。14%通过偶然的胸部X光片检出，30%通过计算机断层扫描检出，7%通过正电子发射断层扫描/计算机断层扫描检出，1%通过磁共振成像检出。
我们观察到在过去7年中肺癌非吸烟者的年发病频率增加了一倍多。患者表现为非特异性症状，多数通过偶然的影像学检查检出，这种检查方式在这个没有任何可观察到的临床风险因素的队列中，对于早期检测可能发挥越来越重要的作用。
