云南省昆明市城市癌症早诊早治项目肺癌高危人群评估及筛查效果分析

·541· 中国肺癌杂志2020年7月第23卷第7期 Chin J Lung Cancer, July 2020, Vol.23, No.7 · 临床研究· 云南省昆明市城市癌症早诊早治项目：肺癌高危人群评估及筛查效果分析林艳苹马洁吴萌周海陆彦霓岑泳村袁中琴梅泽超黄云超周永春【摘要】背景与目的肺癌是最常见的恶性肿瘤，预后较差，5年生存率较低，早期筛查是肺癌防治的重要措施。目前，不同国家和地区发布了相应的肺癌筛查指南，但我国仍缺乏基于中国人群研究的指南。因此，国家癌症中心在全国启动了多中心的城市癌症早诊早治项目研究。本研究分析了城市癌症早诊早治项目中云南省单中心的肺癌高危人群评估模型及临床筛查应用效果，为探索适合我国国情的肺癌高危人群评估模型及制定和更新中国人群肺癌筛查指南提供一定的参考依据。方法采取整群抽样的方法，于2015年1月-2019年12月对云南省昆明市4 个主城区36个街道办事处165,337人进行问卷调查及肺癌风险评估，评估为高风险者进行胸部低剂量计算机断层扫描（low-dose computed tomography, LDCT）筛查。同时对所有参与者进行主动随访和被动随访，获得详细的临床结局，进行统计分析。结果整体人群5年间经病理确诊肺癌患者264例，总体肺癌发生率为0.16%（264/165,337），高风险组（0.31%, 116/37,914）高于非高风险组（0.12%, 148/127,423），差异有统计学意义（P0.001）。不同性别和不同年龄的亚组分析显示高风险组肺癌发生率均高于非高风险组，均有统计学差异（P0.001），但在未进行 LDCT筛查组无统计学差异（P=0.73）。肺癌高危人群评估模型的敏感性为43.94%（116/264），特异性为77.10% （127,275/165,073）。筛查组早诊率为72.97%（54/74），明显高于非筛查组的28.48%（43/151）。结论国家重大公共卫生服务项目城市癌症筛查项目肺癌高危人群评估模型能有效检出高风险人群，提高肺癌早诊率。【关键词】肺肿瘤；筛查；效果；云南 Cancer Screening Program in Urban Kunming of Yunnan: uation of Lung Cancer Risk Assessment and Screening Yanping LIN, Jie MA, Meng WU, Hai ZHOU, Yanni LU, Yongcun CEN, Zhongqin YUAN, Zechao MEI, Yunchao HUANG, Yongchun ZHOU Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China Corresponding author: Yunchao HUANG, E-mail: huangych2001@ ; Yongchun ZHOU, E-mail: chungui7625@ 【Abstract】 Backgroud and objective Lung cancer is the most common neoplasmas with a poor prognosis and a low 5-year survival rate. Early screening is an important measure for the prevention and treatment of lung cancer. At present, different countries have issued corresponding lung cancer screening guidelines, but China still lacks guidelines based on Chi- nese population research. Therefore, the National Cancer Center launched a Multi-center Cancer Screening Program in Urban China. This study analyzed the uation of lung cancer risk assessment model and screening effect in urban China of Yunnan, so as to explore the uation model of high-risk lung cancer population suitable for China s national conditions and develop lung cancer screening guidelines for Chinese. s A questionnaire survey and lung cancer risk assessment were conduct- ed on 165,337 people in 36 street offices in 4 main urban areas of Kunming, Yunnan Province, using cluster sampling from January 2015 to December 2019. People with high-risk of lung cancer conducted low-dose computed tomography (LDCT) screening of chest. What’s more, all participants were followed up by active or passive follow-up. Results There were 264 patients were diagnosed lung cancer by pathology, and the overall incidence of lung cancer was 0.16% (264/165,337). The high-risk group (0.31%, 116/37,914) was higher than the non-high-risk group (0.12%, 148/127,423), and the difference was statistically significant (P0.001). The incidence of lung cancer in the high-risk group was higher than the non-high-risk group D