采用症状和肺量测定术在 SUMMIT 研究肺癌筛查队列中检测 COPD。
Detection of COPD in the SUMMIT Study lung cancer screening cohort using symptoms and spirometry.
机构信息
Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
出版信息
Eur Respir J. 2022 Dec 8;60(6). doi: 10.1183/13993003.00795-2022. Print 2022 Dec.
BACKGROUND
COPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung cancer risk of individuals with symptomatic undiagnosed COPD in a LCS cohort.
METHODS
16 010 current or former smokers aged 55-77 years attended a lung health check as part of the SUMMIT Study. A respiratory consultation and spirometry were performed alongside LCS eligibility assessment. Those with symptoms, no previous COPD diagnosis and airflow obstruction were labelled as undiagnosed COPD. Baseline low-dose computed tomography (LDCT) was performed in those at high risk of lung cancer (PLCO score ≥1.3% and/or meeting USPSTF 2013 criteria).
RESULTS
Nearly one in five (19.7%) met criteria for undiagnosed COPD. Compared with those previously diagnosed, those undiagnosed were more likely to be male (59.1% 53.2%; p<0.001), currently smoking (54.9% 47.6%; p<0.001) and from an ethnic minority group (p<0.001). Undiagnosed COPD was associated with less forced expiratory volume in 1 s impairment (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2: 85.3% 68.4%; p<0.001) and lower symptom/exacerbation burden (GOLD A and B groups: 95.6% 77.9%; p<0.001) than those with known COPD. Multivariate analysis demonstrated that airflow obstruction was an independent risk factor for lung cancer risk on baseline LDCT (adjusted OR 2.74, 95% CI 1.73-4.34; p<0.001), with a high risk seen in those with undiagnosed COPD (adjusted OR 2.79, 95% CI 1.67-4.64; p<0.001).
CONCLUSIONS
Targeted case-finding within LCS detects high rates of undiagnosed symptomatic COPD in those most at risk. Individuals with undiagnosed COPD are at high risk for lung cancer.
背景
慢性阻塞性肺疾病（COPD）是肺癌筛查（LCS）队列中的主要合并症，有大量未确诊的 COPD。在这种情况下，将症状评估与肺活量测定相结合，可能有助于更早诊断有临床意义的 COPD，并增加对 COPD 中肺癌风险的了解。在这项研究中，我们希望了解 LCS 队列中出现有症状的未确诊 COPD 的个体的患病率、严重程度、临床表型和肺癌风险。
方法
16010 名年龄在 55-77 岁的现吸烟者或曾吸烟者参加了 SUMMIT 研究中的肺部健康检查。在进行 LCS 资格评估的同时，进行了呼吸咨询和肺活量测定。那些有症状、没有以前的 COPD 诊断和气流阻塞的人被标记为未确诊的 COPD。在那些肺癌风险较高的人（PLCO 评分≥1.3%和/或符合 USPSTF 2013 标准）中进行了低剂量计算机断层扫描（LDCT）。
结果
近五分之一（19.7%）符合未确诊 COPD 的标准。与以前诊断过的人相比，未确诊的人更有可能是男性（59.1%比 53.2%；p<0.001）、目前吸烟（54.9%比 47.6%；p<0.001）和来自少数民族群体（p<0.001）。未确诊的 COPD 与 1 秒用力呼气量（FEV1）受损程度较轻（全球慢性阻塞性肺疾病倡议（GOLD）分级 1 和 2：85.3%比 68.4%；p<0.001）和较低的症状/加重负担（GOLD A 和 B 组：95.6%比 77.9%；p<0.001）有关。多变量分析表明，气流阻塞是基线 LDCT 肺癌风险的独立危险因素（调整后的 OR 2.74，95%CI 1.73-4.34；p<0.001），在未确诊的 COPD 患者中风险较高（调整后的 OR 2.79，95%CI 1.67-4.64；p<0.001）。
结论
在 LCS 中进行有针对性的病例发现，在风险最高的人群中发现了大量未确诊的有症状的 COPD。未确诊的 COPD 患者患肺癌的风险很高。
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