The Second Department of Medical Oncology, Yunnan Cancer Hospital, Kunming, Yunnan, The People's Republic of China.
Department of Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, The People's Republic of China.
Sci Rep. 2020 Oct 15;10(1):17432. doi: 10.1038/s41598-020-74082-0.
Lung cancer is the leading cause of cancer death worldwide. The Xuanwei-Fuyuan (XF) region of Yunnan, China has a high incidence of lung cancer from coal-related pollution. Effort to raise public awareness screening for lung cancer has been ongoing. We retrospectively analyzed overall survival (OS) of lung cancer patients of a tertiary cancer center in Yunnan to investigate screening and regional residential status as predictive factors. Consecutive cases of newly diagnosed lung cancer were reviewed. The lung cancer cases diagnosed by screening were more likely to be early-staged and treated by surgery than those diagnosed not by screening. In patients diagnosed not by screening, XF residential status was a significant predictor of improved OS. Frailty model detected significant heterogeneity associated with region of residence in unscreened patients. Potential biases associated with screening were examined by Monte Carlo simulations and sensitivity analyses. Focused effort in cancer screening and increased public awareness of pollution-related lung cancer in XF might have led to early diagnosis and improved OS, and increased investment in health care resources in high risk areas may have produced additional unobserved factors that underlay the association of XF residential status with improved OS in patients diagnosed not by screening.
肺癌是全球癌症死亡的主要原因。中国云南省宣威-富源（XF）地区因煤炭相关污染而肺癌发病率较高。提高公众对肺癌筛查的认识的工作一直在进行。我们回顾性分析了云南省一家三级癌症中心肺癌患者的总生存率（OS），以调查筛查和区域性居住状况作为预测因素。连续回顾了新诊断的肺癌病例。筛查诊断的肺癌病例更有可能处于早期阶段，并通过手术治疗，而不是通过筛查诊断的病例。在未通过筛查诊断的患者中，XF 居住状况是 OS 改善的显著预测因素。脆弱性模型检测到与未筛查患者居住地相关的显著异质性。通过蒙特卡罗模拟和敏感性分析检查了与筛查相关的潜在偏差。在 XF 地区，癌症筛查的重点努力和对与污染相关的肺癌的公众认识提高，可能导致了早期诊断和 OS 的改善，而在高风险地区增加对医疗保健资源的投资可能产生了其他未观察到的因素，这些因素是 XF 居住状况与未通过筛查诊断的患者 OS 改善相关的基础。
