低剂量螺旋CT扫描联合血清p16基因甲基化检测在肺癌早期诊断中的应用

Diagnosis of early stage lung cancer by low-dose spiral CT combined with serum p16 gene methylation

目的研究在无症状的肺癌高危人群中利用低剂量CT（LDCT）联合血清p16基因甲基化检测进行肺癌早期诊断的可行性。方法肺癌高危人群入组标准：男性，年龄55～75岁；吸烟指数≥400支／年，目前仍在吸烟或戒烟不超过10年。共893例受检者被随机分为两组。一组为447例（LDCT—p16组），平均年龄66岁，进行LDCT联合血清p16基因甲基化检测；另一组为446例（CXR组），平均年龄67岁，接受后前位胸片检查。两组检查阳性病例将接受进一步组织病理学检查。并分别统计两组阳性结节检出率及肺癌检出率，并行X2检验。结果LDCT—p16组与CXR组分别有96．8％和92．8％的受检者完成了检查。LDCT—p16组中1113％病人可疑肺癌，明显高于CXR组的6．5％（P〈0．05）。其中LDCT—p16组中有7例，CXR组中有2例确诊为肺癌。LDCT—p16组肺癌检出率高于CXR组，但无统计学意义（P〉0．05）。结论低剂量CT联合血清p16基因甲基化检测是一种敏感、安全、可行的筛查早期肺癌的方法，能够取代胸片筛查早期肺癌。

Objective To study the feasibility of detecting lung cancer in asymptomatic high risk group subjects by low-dose spiral CT（LDCT） combined with detection ofpl 6 gene methylation in serum. Methods The standard of enrolled subjects were male, 55 - 75 years old,index of smoking ≥400 pieces per year and either the smoker or the former smoker who withdrawal within 10 years. A total of 893 participants were performed screening by LDCT scan combined with serum p16 gene methylation detection （447 participants） or screening by posteroanterior chest radiograph （CXR） imaging（446 participants） randomizely, suspective lung cancer subjects were further performed histopathologic examination. The detection rates of suspicious nodus and lung cancer were calculated respectively,and analyzed between 2 groups with X2 test. Results The screening was completed for 96.8 % of subjects in LDCT-p16 group and 92.8 % in CXR group. A total of 11.3 % of screened subjects in LDCT-p16 group were found suspective lung cancer more than 6.5 % of those in CXR group（P 〈 0.05）. Seven lung cancers in LDCT-p 16 group and 2 lung cancers in CXR group were diagnosed following the positive screening result. However,there was no significant difference. Conclusion The procedure described in this paper is a sensitive, safe and feasible approach in screening early stage lung cancers by low-dose spiral CT scan combined with detection of p 16 gene methylation in serum. Thus it can be used in screening early lung cancer instead of chest radiograph.