Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina, USA
The Center for Construction Research and Training (CPWR), Silver Spring, Maryland, USA.
Occup Environ Med. 2020 Apr;77(4):207-213. doi: 10.1136/oemed-2019-106196. Epub 2020 Jan 29.
This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.
Predictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.
Factors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.
Results support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.
本研究旨在探讨美国能源部（DOE）工作场所建筑工人肺癌死亡率的预测因素，以更好地确定低剂量 CT（LDCT）肺癌筛查的资格。
预测模型基于 17069 名工人和 352 例肺癌死亡。危险因素包括年龄、性别、种族/民族、吸烟状况、从事贸易或 DOE 工作的年限、体重指数（BMI）、胸部 X 光结果、肺功能结果、呼吸系统症状、铍敏化和癌症个人史。竞争风险 Cox 模型用于获得 HRs 并预测 5 年风险。
除年龄和吸烟外，最终预测模型中还包括胸部 X 光变化、肺功能异常、慢性阻塞性肺疾病（COPD）、呼吸系统症状、BMI、癌症个人史以及在 DOE 工作场所或建筑行业工作 5 年或以上。基于风险的 LDCT 资格与当前美国预防服务工作组指南相比，提高了敏感性、特异性和阳性预测值。在建筑行业或 DOE 工作 5 年的肺癌死亡风险与癌症个人史、癌症家族史或 COPD 诊断的风险相当。用于 DOE 建筑工人的 LDCT 资格标准，除了年龄和吸烟因素外，还确定了 86%的参与者最终会死于肺癌，而仅基于年龄和吸烟的比例为 51%。
结果支持在 LDCT 临床指南中纳入职业暴露和非恶性呼吸系统临床发现的风险。
