高危人群早期肺癌LDCT基线筛查研究  

Study of low-dose computed tomography baseline screening for early lung cancer in high-risk populations

作　　者：李家琳[1] 李骋[2] 陈武飞 齐琳[2] 李铭[2] 毛定飚[2] 滑炎卿[2] 

机构地区：[1]上海中医药大学附属普陀医院放射科,上海200062 [2]复旦大学附属华东医院放射科,上海200040

出　　处：《放射学实践》2017年第3期233-236,共4页Radiologic Practice

基　　金：申康医院发展中心课题(SHDC22015025);复旦大学附属华东医院骨干人才计划项目(HDGG2014011)

摘　　要：目的:探讨肺癌高危人群低剂量CT(LDCT)的筛查效果。方法:5240例上海地区无症状健康人群行胸部LDCT筛查,参照美国国家肺癌筛查试验(NLST)肺癌筛查高危人群入组标准共纳入肺癌高危人群1346例。根据国际早期肺癌行动计划(I-ELCAP)检出结节方案将纳入人群分为阳性、半阳性和阴性三组。根据世界卫生组织年龄分段标准将人群分为中年组和老年组。分析高危人群的高危因素和各组间结节以及肺癌的检出情况。结果:1346例高危入组人群中男894例(66.42%),女452例(33.58%),中位年龄58岁(40~74岁)。吸烟相关高危因素共912例(67.76%)。二手烟暴露率为13.15%,其中女性达96.05%。374例有肿瘤家族史,60例有恶性肿瘤病史。中年组吸烟者占所有吸烟人数的65.46%,老年组占34.54%,差异有统计学意义(P<0.05)。基线筛查共835例(62.04%)受检者检出≥1枚非钙化结节,其中阳性组196例(14.56%),半阳性组639例(47.47%),阴性组511例(37.97%)。阳性组中女性及中年组比例高于半阳性组,差异有统计学意义(P<0.05);吸烟人群阳性组与半阳性组差异有统计学意义(P<0.05)。检出2019枚结节中阳性结节269枚(13.32%),半阳性结节1750枚(86.68%)。最终10例受检者共12枚结节获得病理结果,其中9例病理证实为I期腺癌(包含2例多中心腺癌),1例术后病理证实为机化性肺炎。9例腺癌中,6例为阳性组,3例为半阳性组,阳性组恶性检出率明显高于半阳性组,差异有统计学意义(P<0.05);女4例,男5例,差异有统计学意义(P<0.05)。结论:吸烟仍是肺癌高危人群主要的高危因素,肺癌筛查应关注女性高危人群和中年人群。Objective： The aim of this study was to investigate the consequence of low dose CT （LDCT） baseline screening for early lung cancer in high-risk population. Methods： 5240 healthy participants in Shanghai area underwent chest LDCT scanning for screening. 1346 participants were enrolled as high risk population according to the criterion of National Lung Screening Trial （NLST） of USA. Eligible participants were divided into positive,semi-positive and negative groups on the basis of International Early Lung Cancer Action Program （＆ELCAP） protocol of pulmonary nodules management. In terms of WHO standard of aging, two groups named middle-aged group and old-aged groups were designated. The high risk factors and the detection rate of nodule as well as pulmonary carcinoma in different groups of high risk population were ana lyzed. Results： Of the 1346 high-risk participants, there were 894 males （66.42 %） and 452 females （33.58 %）, the median age was 58y （40~74 y）. The correlated high risk factor of smoking in eligible participants was 912 cases （67.76 %）, with second-hand smoking rate as 13.15% （female 96.05%）. 374 cases had family history of cancer and 60 cases had history of malignancy. The participants of middle-age group accounted for 65.46% of the smoking group and that of the old age group was 34. 54%, with significant statistic difference （P〈0. 05）. According to baseline screening, there were 835 cases （62.04 %） had ≥1 non-calcified nodule detected, 109 cases belonged to positive group. 639 cases belonged to semi positive group. 511 cases （37.97%） were in negative group. The rates of female group and middle age group were higher in positive group as compared with that of semi-positive group,with statistical significance （P〈0.05）. In smokers, the positive group was also higher than that of semi-positive group, with statistical difference （P〈0.05）. Of the 2019 detected puhnonary nod- ules,there were 269 （13.32%） positive nodules and 1750 （86.6

关 键 词：肺肿瘤 体层摄影术 X线计算机 筛查 烟草 女性 高危因素 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]