Lee Jaeho, Kim Yeol, Kim Hyae Young, Goo Jin Mo, Lim Juntae, Lee Choon-Taek, Jang Seung Hun, Lee Won-Chul, Lee Chan Wha, Choi Kui Son, Park Boyoung, Lee Duk Hyoung
National Cancer Control Institute, National Cancer Center, Goyang, Korea.
Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
Transl Lung Cancer Res. 2021 Feb;10(2):723-736. doi: 10.21037/tlcr-20-700.
Lung cancer screening conducted in high-risk group using low-dose computer tomography (LDCT) has been reported as an effective method to reduce lung cancer mortality in two large randomized-control trials. However, the effectiveness is uncertain when lung cancer screening is expanded to a nationwide population-based program.
The Korean Lung Cancer Screening Project (K-LUCAS) is a single-arm cohort study that was conducted from February 2017 to evaluate the feasibility of implementing an organized national lung cancer screening program in Korea. High-risk population aged 55-74 years with more than a 30-pack-year smoking history was recruited. Smoking history was obtained from administering questionnaires at national health screening programs or public smoking cessation programs which are already established programs in Korea. The screening results were reported using the Lung Imaging Reporting and Data System (Lung-RADS), suggested by the American College of Radiology. K-LUCAS was performed by a network-based diagnosis supporting system using a computer-aided detection (CAD) program to maintain screening quality. Current smokers were provided with mandatory smoking counseling.
Among 71,829 participants aged 50 years or older in the national health screening program, 5,975 (8.3%) were eligible for lung cancer screening. Among them, 1,062 (17.8%) refused to participate in K-LUCAS. Additionally, 779 participants were recruited in the smoking cessation program. Thus, a total of 5,692 eligible high-risk participants were recruited in this study. Among them, 865 (15.2%) had positive screening results, which requires a further examination; 529 (9.3%) had Lung-RADS category 3 (indeterminate), and 336 (5.9%) had category 4 (suspicious of lung cancer); 42 (0.7%) had confirmed lung cancer. Approximately 66.7% had early-stage lung cancer: 24 (57.1%), stage I and 4 (9.5%), stage II. Six (1.1%) patients developed complications at the time of diagnosis, including one death. The anxiety level related to cancer screening was low. Participation in screening encouraged motivation to quit smoking.
K-LUCAS provided promising evidence supporting the implementation of a national lung cancer screening program to detect early stage lung cancer and promote smoking cessation for participants in Asian population.
在两项大型随机对照试验中，使用低剂量计算机断层扫描（LDCT）对高危人群进行肺癌筛查已被报道为降低肺癌死亡率的有效方法。然而，当肺癌筛查扩展到全国性的基于人群的项目时，其有效性尚不确定。
韩国肺癌筛查项目（K-LUCAS）是一项单臂队列研究，于2017年2月开展，旨在评估在韩国实施有组织的全国肺癌筛查项目的可行性。招募了年龄在55 - 74岁、吸烟史超过30包年的高危人群。吸烟史通过在韩国已有的全国健康筛查项目或公共戒烟项目中发放问卷获得。筛查结果采用美国放射学会建议的肺部影像报告和数据系统（Lung-RADS）进行报告。K-LUCAS通过基于网络的诊断支持系统使用计算机辅助检测（CAD）程序来维持筛查质量。对当前吸烟者提供强制性吸烟咨询。
在全国健康筛查项目中71,829名50岁及以上的参与者中，5,975名（8.3%）符合肺癌筛查条件。其中，1,062名（17.8%）拒绝参加K-LUCAS。此外，在戒烟项目中招募了779名参与者。因此，本研究共招募了5,692名符合条件的高危参与者。其中，865名（15.2%）筛查结果呈阳性，需要进一步检查；529名（9.3%）为Lung-RADS 3类（不确定），336名（5.9%）为4类（怀疑肺癌）；42名（0.7%）确诊为肺癌。约66.7%为早期肺癌：24名（57.1%）为I期，4名（9.5%）为II期。6名（1.1%）患者在诊断时出现并发症，包括1例死亡。与癌症筛查相关的焦虑水平较低。参与筛查鼓励了戒烟的积极性。
K-LUCAS提供了有前景的证据，支持在亚洲人群中实施全国肺癌筛查项目以检测早期肺癌并促进参与者戒烟。
