Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2019 Jul 30;14(7):e0220610. doi: 10.1371/journal.pone.0220610. eCollection 2019.
More than 50% of the world's lung cancer cases occur in Asia and more than 20% of cancer deaths in Asia are attributable to lung cancer. The U.S. National Lung Screening Trial has shown that lung cancer screening with computed tomography (CT) can reduce lung cancer deaths. Using the Lung Cancer Policy Model-Asia (LCPM-Asia), we estimated the potential mortality reduction achievable through the implementation of CT-based lung cancer screening in China, Japan, Singapore, and South Korea. The LCPM-Asia was calibrated to the smoking prevalence of each of the aforementioned countries based on published national surveys and to lung cancer mortality rates from the World Health Organization. The calibrated LCPM-Asia was then used to simulate lung cancer deaths under screening and no-screening scenarios for the four countries. Using screening eligibility criteria recommended by the U.S. Centers for Medicare & Medicaid Services (CMS), which are based on age and smoking history, we estimated the lung cancer mortality reduction from screening through year 2040. By 2040, lung cancer screening would result in 91,362 life-years gained and 4.74% mortality reduction in South Korea; 290,325 life-years gained and 4.33% mortality reduction in Japan; 3,014,215 life-years gained and 4.22% mortality reduction in China; and 8,118 life-years gained and 3.76% mortality reduction in Singapore. As for mortality reduction by smoker type, current smokers would have the greatest mortality reduction in each country, ranging from 5.56% in Japan to 6.86% in Singapore. Among the four countries, lung cancer screening under CMS eligibility criteria was most effective in South Korea and least effective in Singapore. Singapore's low smoking prevalence and South Korea's aging population and higher smoking prevalence may partially explain the discrepancy in effectiveness. CT screening was shown to be promising as a means of reducing lung cancer mortality in the four countries.
全球超过 50%的肺癌病例发生在亚洲，亚洲超过 20%的癌症死亡归因于肺癌。美国国家肺癌筛查试验表明，使用计算机断层扫描（CT）进行肺癌筛查可以降低肺癌死亡率。利用肺癌政策模型-亚洲（LCPM-Asia），我们估计在中国、日本、新加坡和韩国实施 CT 肺癌筛查可实现的潜在死亡率降低。LCPM-Asia 根据上述国家的公开全国性调查和世界卫生组织的肺癌死亡率，根据每个国家的吸烟率进行了校准。然后，使用校准后的 LCPM-Asia 模拟了这四个国家的筛查和非筛查情景下的肺癌死亡人数。根据美国医疗保险和医疗补助服务中心（CMS）的建议，使用基于年龄和吸烟史的筛查资格标准，我们估计了到 2040 年筛查带来的肺癌死亡率降低。到 2040 年，肺癌筛查将使韩国的预期寿命增加 91,362 年，死亡率降低 4.74%；日本的预期寿命增加 290,325 年，死亡率降低 4.33%；中国的预期寿命增加 3,014,215 年，死亡率降低 4.22%；新加坡的预期寿命增加 8,118 年，死亡率降低 3.76%。就不同吸烟类型的死亡率降低而言，每个国家的当前吸烟者的死亡率降低幅度最大，从日本的 5.56%到新加坡的 6.86%。在这四个国家中，CMS 资格标准下的肺癌筛查在韩国最有效，在新加坡最无效。新加坡的低吸烟率和韩国的人口老龄化和较高的吸烟率可能部分解释了效果的差异。CT 筛查有望成为降低这四个国家肺癌死亡率的一种手段。
