2015-2019年合肥市城市居民肺癌筛查结果分析

Analysis of lung cancer screening for urban residents in Hefei from 2015to 2019

目的系统分析2015-2019年安徽省合肥市城市居民癌症早诊早治项目肺癌筛查结果,评价安徽省肺癌早诊早治的筛查效果,为肺癌的筛查及早诊早治政策制定提供依据。方法2015-01-01-2019-12-31采取整群抽样的方法对合肥市7个区40~69岁的常住城镇居民进行“防癌风险评估问卷”调查,对评估为肺癌高危的居民进行低剂量肺部螺旋CT扫描,筛查肺部阳性结节、疑似肺癌等病变,通过主动随访及被动随访最终确诊肺癌的病例数。结果共完成问卷调查68400人,评估出肺癌高危人群19414例(高危率28.38%),共完成15991例低剂量肺部螺旋CT扫描(筛查参与率82.36%)。检出肺部结节2563例(检出率16.02%),阳性结节779例(检出率4.87%),疑似肺癌116例(检出率0.72%)。确诊肺癌病例为110例,70.91%的病理分期为Tis期及Ⅰ期。采用多项式logistic多元回归分析发现,疑似肺癌与良性结节的发生与吸烟、肿瘤家族史、肺部慢性疾病史有统计学意义的关联,而良性结节同时与高中及以上文化水平有统计学意义的关联,均P<0.05。此次筛查评估为肺癌高危居民的肺癌检出密度为135.38/10万人年;参与CT筛查者肺癌检出密度为168.47/10万人年;其中检出阳性结节及疑似肺癌的肺癌检出密度分别为1735.25/10万人年和8395.42/10万人年。结论城区居民自愿参加肺癌筛查早诊早治项目实施效果较为显著,在高危人群中进行低剂量肺部螺旋CT可有效提高肺癌的早诊率。

Objective To systematically analyze the screening results of early diagnosis and early treatment of cancer project for urban residents in Hefei,Anhui Province from 2015to 2019,and to evaluate the screening effect of early diagnosis and early treatment of lung cancer in Anhui Province,so as to provide a basis to make policy for lung cancer screening and early diagnosis and early treatment.Method From January 2015to December 2019,the cluster sampling method was used to survey native Hefei urban residents whose age ranged from 40to 69by using the"cancer risk assessment questionnaire",and then apply low-dose lung spiral CT scan was used to residents who had been evaluated as high lung cancer risk,screening positive lung nodules and suspected lung lesions.Finally we confirmed the number of lung cancer cases through the active and passive follow-ups.Results From 2015to 2019,a total of 68400patients were surveyed,19414patients were assessed as high risk for lung cancer(high risk rate 28.38%),and a total of 15991patients were evaluated by lowdose lung spiral CT(screening participation rate 82.36%).Pulmonary nodules were detected in 2563patients(the detection rate of nodules was 16.02%),and 779patients had positive nodules(the positive rate was 4.87%),and suspected lung cancer in 116patients(the detection rate of suspected lung cancer was 0.72%).There were 110confirmed cases of lung cancer,and 70.91%of them had pathological stages as Tis and stageⅠ.Using multinomial logistic regression analysis,it was found that the incidence of suspected lung cancer and benign nodules was significantly associated with smoking,family history of tumor and history of chronic pulmonary disease,while benign nodules were also significantly associated with high school education level or above(all P<0.05).Based on the survey results,The lung cancer incidence density of residents at high risk was 135.38/100000person-years,which changed to 168.47per 100000person-years among CT screening participants.The incidence densities of positive nodules and suspected lung cancer were 1735.25/100000person-years and 8395.42/100000person-years,respectively.Conclusion The benefits from implementation of the early diagnosis and early treatment program for lung cancer is quite significant in Anhui Province,and low-dose spiral CT can effectively improve the early diagnosis rate of lung cancer in high-risk population.