Lungs for Living Research Centre, University College London, UK.
Mol Oncol. 2021 Oct;15(10):2544-2564. doi: 10.1002/1878-0261.12864. Epub 2020 Dec 14.
Lung cancer survival statistics are sobering with survival ranking among the poorest of all cancers despite the addition of targeted therapies and immunotherapies. However, improvements in tools for early detection hold promise. The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial recently corroborated the findings from the previous National Lung Screening Trial low-dose Computerised Tomography (NLST) screening trial in reducing lung cancer mortality. Biomarker research and development is increasing at pace as the molecular life histories of lung cancers become further unravelled. Low-dose CT screening (LDCT) is effective but targets only those at the highest risk and is burdensome on healthcare. An optimally designed CT screening programme at best will only detect a low proportion of overall lung cancers as only those at very high-risk meet screening criteria. Biomarkers that help risk stratify suitable patients for LDCT screening, and those that assist in determining which LDCT detected nodules are likely to represent malignant disease are needed. Some biomarkers have been proposed as standalone lung cancer diagnosis tools. Bronchoscopy technology is improving, with better capacity to identify and obtain samples from early lung cancers. Clinicians need to be aware of each early lung cancer detection method's inherent limitations. We anticipate that the future of early lung cancer diagnosis will involve a synergistic, multimodal approach, combining several early detection methods.
肺癌的生存统计数据令人沮丧，尽管加入了靶向治疗和免疫疗法，但其生存率在所有癌症中仍是最差的。然而，早期检测工具的改进带来了希望。荷兰-列日长癌筛查研究（NELSON）试验最近证实了之前国家肺癌筛查试验低剂量计算机断层扫描（NLST）筛查试验的发现，即可以降低肺癌死亡率。随着对肺癌分子生命史的进一步揭示，生物标志物的研究和开发正在加速。低剂量 CT 筛查（LDCT）虽然有效，但仅针对风险最高的人群，而且对医疗保健系统造成负担。最佳设计的 CT 筛查计划最多只能发现一小部分总体肺癌，因为只有那些处于极高风险的人群才符合筛查标准。需要生物标志物来帮助对适合 LDCT 筛查的患者进行风险分层，以及帮助确定 LDCT 检测到的结节是否可能代表恶性疾病。一些生物标志物已被提议作为独立的肺癌诊断工具。支气管镜技术正在不断改进，能够更好地识别和获取早期肺癌的样本。临床医生需要意识到每种早期肺癌检测方法的固有局限性。我们预计，早期肺癌诊断的未来将涉及协同的、多模式的方法，结合几种早期检测方法。
