Sihoe Alan D L, Fong Natalie K Y, Yam Alex S M, Cheng Maria M W, Yau Dorothy L S, Ng Alan W L
CUHK Medical Centre, Hong Kong, China.
Gleneagles Hong Kong Hospital, Hong Kong, China.
J Thorac Dis. 2024 Sep 30;16(9):5890-5898. doi: 10.21037/jtd-24-411. Epub 2024 Sep 26.
Screening with low-dose computed tomography (LDCT) has been proven to potentially reduce the rate of mortality of lung cancer. Lack of real-world data outside of protocolized trials has been cited as an impediment to its more widespread implementation, especially in Asia. This report aims to provide such real-world data.
A single round of LDCT was provided through a community-based charity program in Hong Kong, China to asymptomatic adults with a family history of lung cancer and/or smoking history. Anonymized data from this program were analyzed.
LDCT was performed for 99 participants, including 98 (99%) who had one or more family members with history of lung cancer, and 70 (71%) who were never-smokers. After a single round of screening, a positive LDCT was noted in 47 participants (47%). A sister with a history of lung cancer (28% 8%, P=0.01) and a multiplex family (MF) (47% 23%, P=0.02) were factors associated with a positive LDCT. After a median period of 10 months (range, 5-16 months) following LDCT, lung cancer (all adenocarcinoma) was diagnosed as a direct consequence of positive LDCT findings in six participants (6%), of whom four had stage I disease and five received surgery with curative intent. In the 47 participants with a positive LDCT, having a sister with a history of lung cancer was associated with an increased risk of lung cancer (relative risk =5.23; 95% confidence interval: 1.09-25.21). Detected lesions categorized as Lung Imaging Reporting and Data System (Lung-RADS) 3 or above (odds ratio =12.08; 95% confidence interval: 1.27-114.64) or deemed by an experienced specialist to be suspicious (odds ratio =63.33; 95% confidence interval: 5.48-732.29) were significantly more likely to turn out to be a lung cancer.
This real-world data demonstrates that a single round of LDCT screening at a community level in East Asia can detect potentially curable lung cancer at a rate comparable to those reported by protocolized trials. When considering future LDCT screening programs in East Asia, a family history of lung cancer may be a key factor indicating a person for screening, and how features of a LDCT-detected lesion should trigger further intervention warrant further definition.
低剂量计算机断层扫描（LDCT）筛查已被证明有可能降低肺癌死亡率。缺乏标准化试验之外的真实世界数据被认为是其更广泛应用的障碍，尤其是在亚洲。本报告旨在提供此类真实世界数据。
通过中国香港一项基于社区的慈善项目，为有肺癌家族史和/或吸烟史的无症状成年人提供一轮LDCT检查。对该项目的匿名数据进行分析。
99名参与者接受了LDCT检查，其中98名（99%）有一名或多名肺癌家族史成员，70名（71%）为从不吸烟者。一轮筛查后，47名参与者（47%）LDCT呈阳性。有肺癌家族史的姐妹（28%对8%，P=0.01）和多重家族（MF）（47%对23%，P=0.02）是与LDCT阳性相关的因素。在LDCT检查后的中位10个月（范围5 - 16个月）内，6名参与者（6%）因LDCT阳性结果被诊断为肺癌（均为腺癌），其中4名处于I期，5名接受了根治性手术。在47名LDCT阳性的参与者中，有肺癌家族史的姐妹与肺癌风险增加相关（相对风险=5.23；95%置信区间：1.09 - 25.21）。分类为肺部影像报告和数据系统（Lung-RADS）3级或以上的检测病变（比值比=12.08；95%置信区间：1.27 - 114.64）或经经验丰富的专家认为可疑的病变（比值比=63.33；95%置信区间：5.48 - 732.29）更有可能最终被诊断为肺癌。
这些真实世界数据表明，东亚社区层面的一轮LDCT筛查能够以与标准化试验报告相当的比率检测出潜在可治愈的肺癌。在考虑东亚未来的LDCT筛查项目时，肺癌家族史可能是指示筛查对象的关键因素，以及LDCT检测病变的特征应如何引发进一步干预值得进一步明确。
