Livanou Maria Effrosyni, Syrigos Nikolaos K, Montgomery Austin, Moeckel Camille, Panagiotou Emmanouil, Charpidou Andriani, Mouratidis Ioannis, Georgakopoulos-Soares Ilias, Vathiotis Ioannis A
Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, Athens 11527, Greece.
Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
Lung Cancer. 2023 Dec;186:107424. doi: 10.1016/j.lungcan.2023.107424. Epub 2023 Nov 17.
NELSON and NLST prompted the implementation of lung cancer screening programs in the United States followed by several European countries. This study aimed to assess the sensitivity of different screening criteria among patients with lung cancer in Greece and investigate reasons for ineligibility.
We performed a retrospective analysis on patients with lung cancer referred to the largest referral center in Athens, Greece, between June 2014 and May 2023. The proportion of patients who would meet the updated USPSTF and NLST criteria was compared to the corresponding proportion of the Greek population over 15 years of age.
Out of 2434 patients with lung cancer, 77.4 % (N = 1883) would meet the updated USPSTF criteria, and 58.9 % (N = 1439) would meet the NLST criteria at diagnosis; the corresponding proportions for the Greek population over 15 years would be 13.8 % and 8.2 %, respectively. Ineligible patients were more likely to be female, former or never-smokers, have adenocarcinoma histology, and have driver mutations (p < 0.001).
Although the updated USPSTF criteria demonstrated good sensitivity, a substantial proportion of patients with lung cancer would still not be eligible for screening. Future studies to shape a comprehensive screening strategy should focus on the incorporation of additional risk factors for lung cancer, including air pollution and individual genetic susceptibility.
《纳尔逊研究》和《国家肺癌筛查试验》促使美国随后几个欧洲国家实施了肺癌筛查项目。本研究旨在评估希腊肺癌患者中不同筛查标准的敏感性，并调查不符合筛查标准的原因。
我们对2014年6月至2023年5月期间转诊至希腊雅典最大转诊中心的肺癌患者进行了回顾性分析。将符合更新后的美国预防医学工作组（USPSTF）和《国家肺癌筛查试验》（NLST）标准的患者比例与希腊15岁以上人群的相应比例进行比较。
在2434例肺癌患者中，77.4%（N = 1883）在诊断时符合更新后的USPSTF标准，58.9%（N = 1439）符合NLST标准；希腊15岁以上人群的相应比例分别为13.8%和8.2%。不符合筛查标准的患者更可能为女性、既往吸烟者或从不吸烟者、腺癌组织学类型以及有驱动基因突变（p < 0.001）。
尽管更新后的USPSTF标准显示出良好的敏感性，但仍有相当比例的肺癌患者不符合筛查条件。未来制定综合筛查策略的研究应侧重于纳入肺癌的其他风险因素，包括空气污染和个体遗传易感性。
