2014-2019年北京城市癌症早诊早治项目人群肺癌筛查结果分析

目的分析2014—2019年北京城市癌症早诊早治项目肺癌筛查结果。方法基于国家城市癌症早诊早治项目,以北京市东城、西城、朝阳、海淀、丰台和石景山区的80个筛查项目实施街道为研究现场,采用整群抽样的方法,将街道/居委会所辖的88044名40~69岁北京市户籍居民纳入研究。对问卷初筛肺癌阳性的人群,采用低剂量螺旋CT(LDCT)进行筛查,同时每年通过主动和被动随访相结合的方式对募集的全部人群进行随访,获取其健康结局信息(确诊肺癌/未确诊肺癌)。计算不同特征人群经问卷初筛的肺癌高危率、LDCT筛查参与率、肺部阳性结节检出率、肺癌发病密度(率)、累积发病率以及早诊率;采用Cox比例回归模型计算不同筛查模式下肺癌发生的风险。结果88044名研究对象年龄为(57.4±7.4)岁,其中男性占38.76%(34128例)。问卷初筛肺癌高危率为23.14%,临床筛查参与率为52.26%,肺部阳性结节检出率为10.99%。平均随访3年后,40~69岁男性肺癌发病密度为172.82/10万人年,女性肺癌发病密度为133.52/10万人年;肺癌发生风险随年龄升高而上升(P_趋势<0.001)。问卷初筛阳性人群发病密度为259.22/10万人年;与问卷初筛阴性人群相比,问卷初筛阳性人群肺癌发病风险HR(95%CI)值为2.27(1.83~2.81)。接受LDCT筛查且被判定为阳性结节人群的肺癌发病密度为1825.03/10万人年,3年内的累积发病率为4615.38/10万;与结节阴性人群相比,结节阳性人群肺癌发病风险HR(95%CI)值为13.80(8.91~21.36)。接受LDCT筛查者三年内确诊肺癌的早诊率为70.21%,高于未接受临床筛查者确诊肺癌时的早期比例(45.45%,P=0.016)。结论北京城市癌症早诊早治项目肺癌临床筛查依从性较好;在高危人群中应用LDCT筛查肺癌,能够提高肺癌患者检出率和早诊率。

Lung cancer screening in urban Beijing from 2014 to 2019

Objective To analyze the current status of lung cancer screening among residents in Urban Beijing Cancer Screening Program,2014-2019.Methods Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program,residents aged 40 to 69 were recruited from 80 streets in six districts of Beijing(Dongcheng,Xicheng,Chaoyang,Haidian,Fengtai,and Shijingshan District)by using a cluster sampling method.Subjects who were evaluated as high-risk individuals by using the questionnaire received Low-Dose spiral Computed Tomography(LDCT)screening in designated hospitals.All participants were followed up annually using active and passive follow-up methods to obtain their health outcomes(diagnosed with lung cancer or not).The proportion of high-risk cases evaluated by using the questionnaire,clinical recall rate for receiving LDCT screening,the proportion of cases with positive pulmonary node,incidence rate,cumulative incidence rate,and the proportion of patients with stage 0 orⅠwere calculated.Cox proportional hazard regression model was used to estimate the hazard ratio(HR)and 95%confidence interval(95%CI)among individuals who experienced different screening scenarios.Results A total of 88044 residents with the age of(57.4±7.4)with completed high-risk assessment were included in the analysis.23.14%of participants were evaluated as high-risk individuals by using the questionnaire.The clinical recall rate was 52.26%among the high-risk individuals.The positive rate of pulmonary node detected by LDCT was 10.99%.The incidence rate of lung cancer among males and females aged 40-69 years were 172.82/100000 person-years and 133.52/100000 person-years,respectively after 3 years follow-up.The incidence rates increased with age(Ptrend<0.001).The incidence rate of lung cancer among high-risk individuals was 259.22/100000 person-years,with the HR(95%CI)about 2.27(1.83-2.81)when compared with that among low-risk individuals.The incidence rate and cumulative incidence rate of lung cancer among individuals with positive pulmonary node detected by LDCT were 1825.03/100000 person-years and 4615.38/100000,respectively,with the HR(95%CI)about 13.80(8.91-21.36)when compared with that among individuals with no or negative pulmonary node.The early diagnosis rate among individuals who received LDCT screening was 70.21%,which was higher than that among individuals with no LDCT screening(45.45%).Conclusion Individuals with a high risk of lung cancer in Beijing have a better recall rate of receiving LDCT screening.Using LDCT screening among high-risk individuals is an effective strategy to detect lung cancer cases and improve the early detection rates of lung cancer in Beijing,China.