Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Thorac Cardiovasc Surg. 2020 Sep;160(3):824-831.e4. doi: 10.1016/j.jtcvs.2019.10.145. Epub 2019 Nov 14.
Lung cancer is traditionally more prevalent in the elderly patients, men, and smokers. However, as low-dose computed tomography (LDCT) is increasingly popular, we hypothesized the disease spectrum might change.
LDCT was performed as a part of regular health examinations in 8392 of 15,686 employees from 6 hospitals in different regions of China in 2012 to 2018. Clinicopathologic characteristics, including age, sex, smoking status, radiologic features, tumor histology, and pathologic stage, were retrospectively analyzed.
LDCT incidentally detected lung cancer (pathologically confirmed) in a total of 179 (2.1%) hospital employees. The lung cancer detection rate was significantly greater in female than male (2.5% vs 1.3%, P = .001) patients. There was also a greater detection rate among nonsmokers than smokers, although statistical significance was not reached (2.2% vs 1.4%, P = .092). The lung cancer detection rate was 1.0% in the "age ≤40 years" group, 2.6% in the "40 < age ≤55 years" group, and 2.9% in the "age >55 years" group (P < .001). Among the hospital employees with lung cancer, 171 (95.5%) presented as ground-glass opacity, 177 (98.9%) were lung adenocarcinoma, 170 (95.0%) were early stage 0/IA, and 177 (98.9%) received curative surgical resection as the initial treatment. After a median follow-up of 38 months, no disease recurrence or death was observed among these patients.
LDCT detected lung cancer in a significant proportion of young, female, and nonsmoking employees. The vast majority of these lung cancers were early stage, with extremely good prognosis.
肺癌传统上更常见于老年患者、男性和吸烟者。然而，随着低剂量计算机断层扫描（LDCT）的日益普及，我们假设疾病谱可能会发生变化。
2012 年至 2018 年，在中国六个不同地区的 6 家医院，对 15686 名员工中的 8392 名进行了 LDCT 作为常规健康检查的一部分。回顾性分析了包括年龄、性别、吸烟状况、影像学特征、肿瘤组织学和病理分期在内的临床病理特征。
LDCT 共偶然发现 179 名（2.1%）医院员工的肺癌（经病理证实）。女性患者的肺癌检出率明显高于男性（2.5%比 1.3%，P =.001）。非吸烟者的检出率也高于吸烟者，但无统计学意义（2.2%比 1.4%，P =.092）。在“年龄≤40 岁”组中，肺癌检出率为 1.0%，在“40<年龄≤55 岁”组中为 2.6%，在“年龄>55 岁”组中为 2.9%（P<.001）。在患有肺癌的医院员工中，171 例（95.5%）表现为磨玻璃影，177 例（98.9%）为肺腺癌，170 例（95.0%）为早期 0/IA 期，177 例（98.9%）接受根治性手术切除作为初始治疗。在中位随访 38 个月后，这些患者均未观察到疾病复发或死亡。
LDCT 在相当一部分年轻、女性和非吸烟的员工中检测到肺癌。这些肺癌绝大多数为早期，预后极好。
