背景:观察性研究的证据表明,肺癌筛查(LCS)指南对肺癌(LC)的低诊断率很高,尽管目前的筛查指南已经更新,筛查的资格标准也已经扩大,没有研究比较中国人群中LCS指南的效率。
方法:在2005年至2022年之间,在我们机构使用低剂量计算机断层扫描(LDCT)筛查了31,394名无症状个体。收集人口统计学数据和相关LC危险因素。每个指导标准的LCS效率表示为效率比(ER)。包容率,合格率,LC检测率,并根据ER的不同合格标准对4个指南进行了比较分析。四个指南如下:中国肺癌筛查和早期发现指南(CGSL),国家综合癌症网络(NCCN)美国预防服务工作队(USPSTF),和国际早期肺癌行动计划(I-ELCAP)。
结果:在31,394名参与者中,298(155名妇女,143名男性)被诊断为LC。对于CGSL,NCCN,USPSTF,和I-ELCAP指南,准则的合格率为13.92%,6.97%,6.81%,和53.46%;资格标准的ERe为1.46%,1.64%,1.51%,和1.13%,分别是;对于包容率,他们是19.0%,9.5%,9.3%,73.0%,分别。符合CGSL筛选标准的LC,NCCN,USPSTF,I-ELCAP指南为29.2%,16.4%,14.8%,和86.6%,分别。CGSL的年龄和吸烟标准更严格,因此导致符合筛查标准的LC比率较低。CGSL,NCCN,USPSTF指南显示,45-49岁年龄组的漏诊率最高(17.4%),而I-ELCAP指南显示35-39岁年龄组的漏诊率最高(3.0%)。根据四个指南的标准,男性和女性的资格显着不同(P<0.001)。
结论:I-ELCAP指南对男性和女性的合格率最高。但是对于指南认为合格的人,其实际效率比率最低。而NCCN指南对于那些被指南认为符合条件的人具有最高的ERe值。
BACKGROUND: Evidence from observational studies indicates that lung cancer screening (LCS) guidelines with high rates of lung cancer (LC) underdiagnosis, and although current screening guidelines have been updated and eligibility criteria for screening have been expanded, there are no studies comparing the efficiency of LCS guidelines in Chinese population.
METHODS: Between 2005 and 2022, 31,394 asymptomatic individuals were screened using low-dose computed tomography (LDCT) at our institution. Demographic data and relevant LC risk factors were collected. The efficiency of the LCS for each
guideline criteria was expressed as the efficiency ratio (ER). The inclusion rates, eligibility rates, LC detection rates, and ER based on the different eligibility criteria of the four guidelines were comparatively analyzed. The four
guidelines were as follows: China
guideline for the screening and early detection of lung cancer (CGSL), the National Comprehensive Cancer Network (NCCN), the United States Preventive Services Task Force (USPSTF), and International Early Lung Cancer Action Program (I-ELCAP).
RESULTS: Of 31,394 participants, 298 (155 women, 143 men) were diagnosed with LC. For CGSL, NCCN, USPSTF, and I-ELCAP
guidelines, the eligibility rates for
guidelines were 13.92%, 6.97%, 6.81%, and 53.46%; ERe for eligibility criteria were 1.46%, 1.64%, 1.51%, and 1.13%, respectively; and for the inclusion rates, they were 19.0%, 9.5%, 9.3%, and 73.0%, respectively. LCs which met the screening criteria of CGSL, NCCN, USPSTF, and I-ELCAP guidelines were 29.2%, 16.4%, 14.8%, and 86.6%, respectively. The age and smoking criteria for CGSL were stricter, hence resulting in lower rates of LC meeting the screening criteria. The CGSL, NCCN, and USPSTF guidelines showed the highest underdiagnosis in the 45-49 age group (17.4%), while the I-ELCAP guideline displayed the highest missed diagnosis rate (3.0%) in the 35-39 age group. Males and females significantly differed in eligibility based on the criteria of the four guidelines (P < 0.001).
CONCLUSIONS: The I-ELCAP guideline has the highest eligibility rate for both males and females. But its actual efficiency ratio for those deemed eligible by the
guideline was the lowest. Whereas the NCCN
guideline has the highest ERe value for those deemed eligible by the
guideline.