Chen Xing, Kanhar Ghulam Muhammad, Hu Songli, Wu Chaomin, Chao Guanqun, Jing Mengqi, Zhang Fengjiang, Young Millennia, Kimmel Marek, Chen Liying, Gorlova Olga Y
Department of Medicine, Zhejiang Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, Hangzhou, Zhejiang, China.
PLoS One. 2025 Jan 3;20(1):e0313544. doi: 10.1371/journal.pone.0313544. eCollection 2025.
It is significant to know how much early detection and screening could reduce the proportion of occult metastases and benefit NSCLC patients.
We used previously designed and validated mathematical models to obtain the characteristics of LC in the population including undetectable metastases at the time of diagnosis. The survival was simulated using the survival functions from Surveillance, Epidemiology and End Results (SEER) data stratified by stage.
Based on the simulations, 35.3% of patients diagnosed with stage N0M0 and 56.9% of those diagnosed with stage N1M0 had nodal or distant metastases that were not discovered at the time of diagnosis. Among clinically detected Stage I lung cancers with tumor diameter 1-2 cm, 78% were true stage N0M0 (no occult metastases) while it was only 37% for patients with tumor diameters of 2-3 cm. This size threshold can be translated into a 0.75-year the "window of opportunity" for the curable disease. In a comparative analysis of two simulated groups of individuals: (1) clinically diagnosed (2) diagnosed by screening with a varying screening frequency (quarterly, biannual, annual and biennial), it was estimated that, once the screening intervals become shorter, substantially more cancers are found, but at an expense of a higher radiation exposure. The simulation projected that the mortality reduction in screened patients depending on the frequency, ranged from 15.04% to 18.82%.
The probability of occult metastases significantly increases when the primary tumor exceeds 2 cm in diameter. Effective screening measures that detect smaller tumors will considerably benefit asymptomatic LC patients.
了解早期检测和筛查能在多大程度上降低隐匿性转移的比例并使非小细胞肺癌（NSCLC）患者获益具有重要意义。
我们使用先前设计并验证的数学模型来获取人群中肺癌（LC）的特征，包括诊断时未检测到的转移情况。使用监测、流行病学和最终结果（SEER）数据按阶段分层的生存函数来模拟生存情况。
基于模拟，诊断为N0M0期的患者中有35.3%以及诊断为N1M0期的患者中有56.9%在诊断时存在未被发现的淋巴结或远处转移。在临床检测到的肿瘤直径为1 - 2 cm的I期肺癌中，78%为真正的N0M0期（无隐匿性转移），而肿瘤直径为2 - 3 cm的患者中这一比例仅为37%。这个大小阈值可转化为可治愈疾病的0.75年“机会窗口”。在对两组模拟个体的比较分析中：（1）临床诊断的（2）以不同筛查频率（每季度、半年、每年和每两年）进行筛查诊断的，估计一旦筛查间隔变短，发现的癌症会显著增多，但代价是辐射暴露增加。模拟预测，根据频率不同，筛查患者的死亡率降低范围为15.04%至18.82%。
当原发肿瘤直径超过2 cm时，隐匿性转移的概率显著增加。检测较小肿瘤的有效筛查措施将使无症状肺癌患者显著获益。
