Salomaa E R, Liippo K, Taylor P, Palmgren J, Haapakoski J, Virtamo J, Heinonen O P
Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Finland.
Chest. 1998 Dec;114(6):1514-8. doi: 10.1378/chest.114.6.1514.
The prognosis of patients with lung cancer is better when the diagnosis is made early; the disease is localized, and radical surgery is possible. Screening for lung cancer with mass radiography or sputum cytology should contribute to a more favorable prognosis. Large-scale screening studies have improved the survival rates for lung cancer but have yielded no reduction in mortality rates.
The histologic types, stages, treatments, and survival rates were studied in 93 men who were found to have lung cancer in a single chest radiograph screening of more than 33,000 men who smoked and were 50 to 69 years old ("screened cases"), and in 239 men of the same age range whose lung cancer was detected through ordinary health care system ("other cases") during the screening period.
The distribution of the histology was similar in the two groups, but screening detected more instances of early-stage disease that were resectable more often than in the other group (37 vs 19%). The 5-year survival rate for men in the screened cases was 19%, and that of men in the other cases was 10% (relative risk, 0.65; 95% confidence interval [CI], 0.50 to 0.84). The survival rate of men in the screened cases remained significantly higher than that of men in the other cases even after adjustments for age, smoking status, histology, stage of the disease, and resectability of the disease (relative risk, 0.74; 95% CI, 0.55 to 1.00).
According to this study, chest radiograph screening might improve the prognosis of lung cancer. Our results are, however, subject to many factors that were only partially controlled for, and they should be interpreted cautiously.
肺癌患者若能早期诊断，疾病局限且可行根治性手术，则预后较好。采用胸部X线摄影或痰细胞学检查进行肺癌筛查应有助于改善预后。大规模筛查研究提高了肺癌患者的生存率，但并未降低死亡率。
对超过33000名年龄在50至69岁的吸烟男性进行单次胸部X线摄影筛查，从中发现93例肺癌男性患者（“筛查病例”），并对239例在筛查期间通过普通医疗保健系统检测出肺癌的同年龄范围男性患者（“其他病例”）的组织学类型、分期、治疗方法和生存率进行了研究。
两组的组织学分布相似，但筛查发现的早期疾病病例更多，且比另一组更常可切除（37%对19%）。筛查病例组男性的5年生存率为19%，其他病例组男性为10%（相对风险，0.65；95%置信区间[CI]，0.50至0.84）。即使在对年龄、吸烟状况、组织学、疾病分期和疾病可切除性进行调整后，筛查病例组男性的生存率仍显著高于其他病例组男性（相对风险，0.74；95%CI，0.55至1.00）。
根据本研究，胸部X线摄影筛查可能改善肺癌的预后。然而，我们的结果受到许多仅部分得到控制的因素影响，应谨慎解读。
