低剂量计算机断层扫描（LDCT）肺癌筛查在亚洲女性不吸烟者中的效果与亚洲男性吸烟者一样有效：系统评价和荟萃分析。
Low-Dose Computed Tomography (LDCT) Lung Cancer Screening in Asian Female Never-Smokers Is as Efficacious in Detecting Lung Cancer as in Asian Male Ever-Smokers: A Systematic Review and Meta-Analysis.
机构信息
Department of Medicine, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
Department of Medicine, Division of Hematology-Oncology, University of California Irvine School of Medicine, Orange, California.
出版信息
J Thorac Oncol. 2023 Jun;18(6):698-717. doi: 10.1016/j.jtho.2023.01.094. Epub 2023 Feb 10.
INTRODUCTION
Lung cancer in never-smokers is the major cancer cause of death globally. We compared the efficacy of low-dose computed tomography (LDCT) lung cancer screening among never-smokers versus ever-smokers using systematic review and meta-analysis.
METHODS
LDCT lung cancer screening studies that simultaneously included both ever-smoker and never-smoker participants published by April 30, 2021, were searched through PubMed and Scopus. Primary outcome measure was relative risk (RR) of lung cancer diagnosed among never-smokers versus ever-smokers.
RESULTS
A total of 14 studies (13 from Asia) were included (141,396 ever-smokers, 109,251 never-smokers, 1961 lung cancer cases diagnosed). RR of lung cancer diagnosed between ever-smokers versus never-smokers overall was 1.21 (95% confidence interval [CI]: 0.89-1.65), 1.37 (95% CI: 1.08-1.75) among males, and 0.88 (95% CI: 0.59-1.31) among females. RR was 1.78 (95% CI: 1.41-2.24) and 1.22 (95% CI: 0.89-1.68) for Asian female never-smokers versus male never-smokers and versus male ever-smokers, respectively, and 0.99 (95% CI: 0.65-1.50) versus high-risk ever-smokers (≥30 pack-years). Proportional meta-analysis revealed significantly more lung cancers diagnosed at first scan (95.4% [95% CI: 84.9-100.0] versus 70.9% [95% CI: 54.6-84.9], p = 0.010) and at stage 1 (88.5% [95% CI: 79.3-95.4] versus 79.7% [95% CI: 71.1-87.4], p = 0.071) among never-smokers versus ever-smokers, respectively. RR of lung cancer death and 5-year all-cause mortality in never-smokers versus ever-smokers was 0.27 (95% CI: 0.1-0.55, p < 0.001) and 0.13 (95% CI: 0.05-0.33, p < 0.001), respectively.
CONCLUSIONS
The RR of lung cancer detected by LDCT screening among female never-smokers and male ever-smokers in Asia was statistically similar. Overall and lung cancer specific mortality from the lung cancer diagnosed from LDCT screening was significantly reduced among never-smokers compared to ever-smokers.
简介
在全球范围内，不吸烟人群的肺癌是主要癌症死因。我们通过系统评价和荟萃分析比较了低剂量计算机断层扫描（LDCT）肺癌筛查在不吸烟人群和吸烟人群中的效果。
方法
检索截至 2021 年 4 月 30 日发表的同时包含吸烟和不吸烟参与者的 LDCT 肺癌筛查研究，检索工具为 PubMed 和 Scopus。主要观察指标为不吸烟人群与吸烟人群中诊断出的肺癌的相对风险（RR）。
结果
共纳入 14 项研究（均来自亚洲）（141396 名吸烟参与者，109251 名不吸烟参与者，1961 例肺癌病例）。总体而言，吸烟人群与不吸烟人群相比，肺癌的 RR 为 1.21（95%置信区间[CI]：0.89-1.65），男性为 1.37（95% CI：1.08-1.75），女性为 0.88（95% CI：0.59-1.31）。亚洲女性不吸烟者与男性不吸烟者和男性吸烟者相比，RR 分别为 1.78（95% CI：1.41-2.24）和 1.22（95% CI：0.89-1.68），与高风险吸烟者（≥30 包年）相比为 0.99（95% CI：0.65-1.50）。比例荟萃分析显示，不吸烟者首次扫描时诊断出的肺癌比例明显更高（95.4%[95% CI：84.9-100.0] vs. 70.9%[95% CI：54.6-84.9]，p=0.010），且分期为 1 期的比例也更高（88.5%[95% CI：79.3-95.4] vs. 79.7%[95% CI：71.1-87.4]，p=0.071）。不吸烟者与吸烟者相比，肺癌死亡和 5 年全因死亡率的 RR 分别为 0.27（95% CI：0.1-0.55，p<0.001）和 0.13（95% CI：0.05-0.33，p<0.001）。
结论
亚洲女性不吸烟者和男性吸烟者中通过 LDCT 筛查检出肺癌的 RR 统计学上相似。与吸烟者相比，不吸烟者接受 LDCT 筛查诊断出的肺癌的总体和肺癌特异性死亡率显著降低。
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