广州女性低剂量CT肺癌筛查结果及高危因素探索  

Results of Lung Cancer Screening with Low-dose Computed Tomography and Exploration of Risk Factors in Guangzhou

作　　者：卢炫庄 邱秋霞 杨春玉 黎才琛 李坚福 熊珊 程博 周楚静 杜小芹 张屹 何建行[1,2,3] 梁文华 钟南山[1,2,5] Xuanzhuang LU;Qiuxia QIU;Chunyu YANG;Caichen LI;Jianfu LI;Shan XIONG;Bo CHENG;Chujing ZHOU;Xiaoqin DU;Yi ZHANG;Jianxing HE;Wenhua LIANG;Nanshan ZHONG(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Nanshan School,Guangzhou Medical University,Guangzhou 511436,China;Guangzhou Municipal Health Commission,Guangzhou 510080,China;Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广州医科大学附属第一医院,广州510120 [2]广州呼吸健康研究院,广州510120 [3]广州医科大学南山学院,广州511436 [4]广州市卫生健康委员会,广州510080 [5]南方医科大学,广州510515

出　　处：《中国肺癌杂志》2024年第5期345-358,共14页Chinese Journal of Lung Cancer

基　　金：广州国家实验室重点项目(No.SRPG22-017)资助。

摘　　要：背景与目的肺癌高居中国恶性肿瘤发病率和死亡率之首。既往肺癌筛查试验大多为针对吸烟者等高危人群的选择性筛查,然而亚洲肺癌病例非吸烟女性占相当比例。本研究旨在评估广州市社区女性的肺癌患病率并探究肺癌高危因素。方法采用胸部低剂量计算机断层扫描(low-dose computed tomography,LDCT)对广州市40-74岁女性居民行肺癌筛查,并根据2018版《中国肺癌低剂量螺旋CT筛查指南》对肺结节进行分类管理及计算阳性结节和肺癌检出率。筛查对象在行检查前均须完成“肺癌危险因素调研问卷”,后对问卷危险因素进行最小绝对收缩和选择算子惩罚Logistic回归分析。结果分析共纳入6256名女性,发现阳性结节1228例(19.63%),确诊肺癌117例(1.87%),其中原位癌6例,I期103例(占肺癌比例88.03%)。根据问卷变量行最小绝对收缩和选择算子(Least absolute shrinkage and selection operator,LASSO)惩罚Logistic回归分析发现,年龄≥50岁(OR=1.07,95%CI:1.06-1.07)、个人恶性肿瘤史(OR=3.29,95%CI:3.22-3.37)、纺织职业(OR=1.10,95%CI:1.08-1.13)、小时候使用煤为燃料(OR=1.14,95%CI:1.13-1.16)以及食物过敏史(OR=1.10,95%CI:1.07-1.13)是该地区女性肺癌的高危因素。结论胸部LDCT可以发现大量早期肺癌,可用于女性肺癌筛查。年龄≥50岁、个人恶性肿瘤史、纺织职业、小时候使用煤为燃料和食物过敏史是该地区女性人群肺癌的高危因素,需提高该群体对肺癌早筛的重视程度。Background and objective Both of lung cancer incidence and mortality rank first among all cancers in China.Previous lung cancer screening trials were mostly selective screening for high-risk groups such as smokers.Non-smoking women accounted for a considerable proportion of lung cancer cases in Asia.This study aimed to evaluate the outcome of community-based mass screening in Guangzhou and identify the high-risk factors for lung cancer.Methods Residents aged 40-74 years in Guangzhou were screened with low-dose computed tomography(LDCT)for lung cancer and the pulmonary nodules were classified and managed according to China National Lung Cancer Screening Guideline with Low-dose Computed Tomography(2018 version).The detection rate of positive nodules was calculated.Before the LDCT examination,residents were required to complete a"lung cancer risk factors questionnaire".The risk factors of the questionnaire were analyzed by least absolute shrinkage and selection operator(LASSO)penalized Logistic regression analysis.Results A total of 6256 residents were included in this study.1228 positive nodules(19.63%)and 117 lung cancers were confirmed,including 6 cases of Tis,103 cases of stage I(accounting for 88.03%of lung cancer).The results of LASSO penalized Logistic regression analysis indicated that age≥50 yr(OR=1.07,95%CI:1.06-1.07),history of cancer(OR=3.29,95%CI:3.22-3.37),textile industry(OR=1.10,95%CI:1.08-1.13),use coal for cooking in childhood(OR=1.14,95%CI:1.13-1.16)and food allergy(OR=1.10,95%CI:1.07-1.13)were risk factors of lung cancer for female in this district.Conclusion This study highlighted that numerous early stages of lung cancer cases were detected by LDCT,which could be applied to screening of lung cancer in women.Besides,age≥50 yr,personal history of cancer,textile industry and use coal for cooking in childhood are risk factors for women in this district,which suggested that it’s high time to raise the awareness of early lung cancer screening in this group.

关 键 词：肺肿瘤 低剂量CT 早期筛查 高危因素 

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