Kakinuma Ryutaro, Muramatsu Yukio, Asamura Hisao, Watanabe Shun-Ichi, Kusumoto Masahiko, Tsuchida Takaaki, Kaneko Masahiro, Tsuta Koji, Maeshima Akiko Miyagi, Ishii Genichiro, Nagai Kanji, Yamaji Taiki, Matsuda Takahisa, Moriyama Noriyuki
Cancer Screening Division, National Cancer Center, Research Center for Cancer Prevention and Screening, Tokyo, Japan.
Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
Transl Lung Cancer Res. 2020 Feb;9(1):10-22. doi: 10.21037/tlcr.2020.01.13.
This was an observational study of Japanese participants who underwent low-dose computed tomographic (LDCT) lung cancer screening between February 2004 and March 2012, to evaluate the lung cancers in never-smokers and smokers.
The study population consisted of a total of 12,114 subjects [never-smokers, 6,021 (49.70%); smokers with <30 pack-years of smoking, 3,785 (31.24%); smokers with ≥30 pack-years of smoking, 2,305 (19.03%); unknown smoking status, 3 (0.02%)]. The odds ratio (OR) of lung cancer detection according to the smoking status adjusted for age and gender was evaluated.
A total of 152 lung cancers were diagnosed in 133 patients [never-smokers, 66 (49.6%); smokers with <30 pack-years of smoking, 31 (23.3%); smokers with ≥30 pack-years of smoking, 36 (27.1%)]; therefore, 72.9% of lung cancer patients did not meet the National Lung Screening Trial (NLST) criterion of smokers with ≥30 pack-years of smoking. The OR of lung cancer detection in smokers with ≥30 pack-years of smoking was higher than that in the never-smokers (OR =1.71, 95% CI: 1.04-2.82, P=0.03) and that in smokers with <30 pack-years of smoking (OR =1.71, 95% CI: 1.04-2.80, P=0.03), while the OR of lung cancer detection in smokers with <30 pack-years of smoking was the same as that in the never-smokers (OR =1.00, 95% CI: 0.62-1.61, P=0.99).
Although the OR of lung cancer detection in smokers with ≥30 pack-years of smoking was higher than that in the never-smokers and smokers with <30 pack-years of smoking, approximately 70% of lung cancer patients might be missed if we only adopted the NLST criterion of smokers with ≥30 pack-years of smoking. Therefore, never-smokers and smokers with <30 pack-years of smoking should be included in the target population for LDCT lung cancer screening in Japan.
这是一项对2004年2月至2012年3月期间接受低剂量计算机断层扫描（LDCT）肺癌筛查的日本参与者进行的观察性研究，旨在评估从不吸烟者和吸烟者中的肺癌情况。
研究人群共有12114名受试者[从不吸烟者6021名（49.70%）；吸烟量<30包年的吸烟者3785名（31.24%）；吸烟量≥30包年的吸烟者2305名（19.03%）；吸烟状况未知者3名（0.02%）]。评估了根据年龄和性别调整吸烟状况后的肺癌检测比值比（OR）。
133名患者共诊断出152例肺癌[从不吸烟者66例（49.6%）；吸烟量<30包年的吸烟者31例（23.3%）；吸烟量≥30包年的吸烟者36例（27.1%）]；因此，72.9%的肺癌患者不符合美国国家肺癌筛查试验（NLST）中吸烟量≥30包年的吸烟者标准。吸烟量≥30包年的吸烟者的肺癌检测OR高于从不吸烟者（OR = 1.71，95%CI：1.04 - 2.82，P = 0.03）以及吸烟量<30包年的吸烟者（OR = 1.71，95%CI：1.04 - 2.80，P = 0.03），而吸烟量<30包年的吸烟者的肺癌检测OR与从不吸烟者相同（OR = 1.00，95%CI：0.62 - 1.61，P = 0.99）。
尽管吸烟量≥30包年的吸烟者的肺癌检测OR高于从不吸烟者和吸烟量<30包年的吸烟者，但如果仅采用NLST中吸烟量≥30包年的吸烟者标准，大约70%的肺癌患者可能会被漏诊。因此，从不吸烟者和吸烟量<30包年的吸烟者应纳入日本LDCT肺癌筛查的目标人群。
