Liu Ya, Feng Zhuowei, Fan Zeyu, Zhang Yu, Li Chenyang, Liu Xiaomin, Duan Hongyuan, Cui Xiaonan, Zhang Liwen, Sheng Chao, Yang Lei, Gao Ying, Wang Xing, Zhang Qing, Lyu Zhangyan, Song Fangfang, Huang Yubei, Song Fengju
Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.
Department of Radiology, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Front Oncol. 2023 Jul 18;13:1203320. doi: 10.3389/fonc.2023.1203320. eCollection 2023.
Despite the increasing use of computed tomography (CT), chest X-ray (CXR) remains the first-line investigation for suspected lung cancer (LC) in primary care. However, the associations of CXR trajectories, smoking and LC risk remain unknown.
A total of 52,486 participants from the PLCO and 22,194 participants from the NLST were included. The associations of CXR trajectories with LC risk were evaluated with multivariable COX regression models and pooled with meta-analyses. Further analyses were conducted to explore the stratified associations by smoking status and the factors associated with progression and regression in CXR.
Compared to stable negative CXR (CXR), HRs (95%CIs) of LC incidence were 2.88(1.50-5.52), 3.86(2.03-7.35), and 1.08(0.80-1.46) for gain of positive CXR (CXR), stable positive CXR (CXR), and loss of positive CXR (CXR), while the risk of LC mortality were 1.58(1.33-1.87), 2.56(1.53-4.29), and 1.05(0.89-1.25). Similar trends were observed across different smoking status. However, LC risk with CXR overweighed that with CXR among ever smokers [2.95(2.25-3.88) . 2.59(1.33-5.02)] and current smokers [2.33(1.70-3.18) . 2.26(1.06-4.83)]. Moreover, compared to CXR among never smokers, even no progression in CXR, the HRs(95%CIs) of LC incidence were 7.39(5.60-9.75) and 31.45(23.58-41.95) for ever and current smokers, while risks of LC mortality were 6.30(5.07-7.81) and 27.17(21.65-34.11). If participants gained positive CXR, LC incidence risk significantly climbed to 22.04(15.37-31.60) and 71.97(48.82-106.09) for ever and current smokers, while LC mortality risk climbed to 11.90(8.58-16.50) and 38.92(27.04-56.02). CXR was associated with decreased LC risk. However, even smokers lost their positive CXR, and the increased risks of LC incidence and mortality did not decrease to non-significant level. Additionally, smoking was significantly associated with increased risk of CXR but not CXR.
LC risk differed across CXR trajectories and would be modified by smoking status. Comprehensive intervention incorporating CXR trajectories and smoking status should be recommended to reduce LC risk.
尽管计算机断层扫描（CT）的使用日益增加，但胸部X线（CXR）仍是基层医疗中疑似肺癌（LC）的一线检查方法。然而，CXR轨迹、吸烟与LC风险之间的关联尚不清楚。
纳入了来自PLCO的52486名参与者和来自NLST的22194名参与者。使用多变量COX回归模型评估CXR轨迹与LC风险的关联，并通过荟萃分析进行汇总。进一步分析以探讨吸烟状态的分层关联以及与CXR进展和消退相关的因素。
与稳定的阴性CXR相比，阳性CXR增加、稳定的阳性CXR和阳性CXR消失时LC发病的HR（95%CI）分别为2.88（1.50 - 5.52）、3.86（2.03 - 7.35）和1.08（0.80 - 1.46），而LC死亡风险分别为1.58（1.33 - 1.87）、2.56（1.53 - 4.29）和1.05（0.89 - 1.25）。在不同吸烟状态中观察到类似趋势。然而，在曾经吸烟者[2.95（2.25 - 3.88）. 2.59（1.33 - 5.02）]和当前吸烟者[2.33（1.70 - 3.18）. 2.26（1.06 - 4.83）]中，CXR阳性时的LC风险高于CXR阴性时。此外，与从不吸烟者的CXR相比，即使CXR无进展，曾经吸烟者和当前吸烟者LC发病的HR（95%CI）分别为7.39（5.60 - 9.75）和31.45（23.58 - 41.95），而LC死亡风险分别为6.30（5.07 - 7.81）和27.17（21.65 - 34.11）。如果参与者CXR转为阳性，曾经吸烟者和当前吸烟者的LC发病风险显著升至22.04（15.37 - 31.60）和71.97（48.82 - 106.09），而LC死亡风险升至11.90（8.58 - 16.50）和38.92（27.04 - 56.02）。CXR阴性与LC风险降低相关。然而，即使吸烟者CXR转为阴性，LC发病和死亡风险增加并未降至非显著水平。此外，吸烟与CXR阳性风险增加显著相关，但与CXR阴性无关。
LC风险因CXR轨迹而异，并会因吸烟状态而改变。应建议采取综合干预措施，结合CXR轨迹和吸烟状态以降低LC风险。
