| 金晨颖,朱陈,吉晨,李樵,付雅婷,吴丽丽,石磊,杜灵彬,朱猛,沈洪兵,马红霞.肺癌高风险人群中肺结节与肺癌发病风险的关联研究[J].中华流行病学杂志,2025,46(2):273-279 |
| 肺癌高风险人群中肺结节与肺癌发病风险的关联研究 |
| Association between lung nodules and lung cancer risk in high-risk populations |
| 收稿日期:2024-06-27 出版日期:2025-02-14 |
| DOI：10.3760/cma.j.cn112338-20240627-00381 |
| 中文关键词: 实性结节 纯磨玻璃结节 部分实性结节 肺癌筛查 |
| 英文关键词: Solid nodule Pure ground glass nodule Part solid nodule Lung cancer screening |
| 基金项目:国家自然科学基金优秀青年基金（81922061） |
| 作者 | 单位 | E-mail | | 金晨颖 | 南京医科大学公共卫生学院流行病学系, 南京 211166 | | | 朱陈 | 南京医科大学公共卫生学院流行病学系, 南京 211166
浙江省肿瘤医院, 杭州 310022 | | | 吉晨 | 南京医科大学公共卫生学院流行病学系, 南京 211166 | | | 李樵 | 南京医科大学公共卫生学院流行病学系, 南京 211166 | | | 付雅婷 | 南京医科大学公共卫生学院流行病学系, 南京 211166 | | | 吴丽丽 | 浙江省台州市肿瘤医院, 温岭 317500 | | | 石磊 | 浙江省肿瘤医院, 杭州 310022 | | | 杜灵彬 | 浙江省肿瘤医院, 杭州 310022 | | | 朱猛 | 南京医科大学公共卫生学院流行病学系, 南京 211166
南京医科大学省部共建肿瘤个体化医学协同创新中心, 南京 211166 | | | 沈洪兵 | 南京医科大学公共卫生学院流行病学系, 南京 211166
南京医科大学省部共建肿瘤个体化医学协同创新中心, 南京 211166 | | | 马红霞 | 南京医科大学公共卫生学院流行病学系, 南京 211166
南京医科大学省部共建肿瘤个体化医学协同创新中心, 南京 211166 | hongxiama@njmu.edu.cn |
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| 中文摘要: |
| 目的 探讨肺癌高风险人群中不同特征肺结节与肺癌发病风险的关联，为肺结节综合管理提供流行病学依据。方法 利用浙江省温岭市开展的低剂量螺旋CT（LDCT）肺癌免费筛查项目，收集2019年4月至2021年10月接受LDCT筛查的肺癌高危人群基线和影像学信息，剔除既往肺癌、肺结核、尘肺及矽肺病史的患者，共纳入28 539名研究对象进行分析，随访截至2023年12月31日。根据检出肺结节特征，将研究对象分为无结节组、实性结节组、纯磨玻璃结节组和部分实性结节组。以随访期间新诊断肺癌为结局，采用Cox比例风险回归模型分析不同特征肺结节与肺癌发病风险的关联。结果 平均径≥3 mm的肺结节总体检出率为76.5%，其中实性结节、纯磨玻璃结节和部分实性结节检出率分别为53.7%、18.2%和4.6%。不同结节组在年龄、性别、BMI、文化程度、有害物质接触史、吸烟状况、肺部疾病史以及肺癌家族史方面差异有统计学意义（均P<0.05）。研究对象的随访时间M为3.4年，随访期间共诊断新发肺癌485名。多因素Cox比例风险回归模型分析结果显示，与实性结节相比，纯磨玻璃结节和部分实性结节的肺癌发病风险更高，HR值（95%CI）分别为1.89（1.52~2.35）和6.49（5.18~8.14）。亚组分析结果显示，部分实性结节组的患者肺癌发病风险在各组人群中均最高，其次为纯磨玻璃结节组的患者。年龄较大或曾患有肺部疾病的实性结节组患者肺癌发病风险更高，部分实性结节组的肺癌发病风险在不同性别间存在异质性。结论 肺癌高风险人群中，肺结节检出比例高，其中纯磨玻璃结节和部分实性结节患者发展为肺癌的风险更高，应更重视针对年龄较大或曾患有肺部疾病的实性结节患者以及女性部分实性结节患者的年度随访管理。 |
| 英文摘要: |
| Objective To investigate the association between different types of lung nodules and the risk of lung cancer in a population at high risk of lung cancer and to provide an epidemiologic basis for the comprehensive management of lung nodules. Methods Using the free lung cancer screening program of low-dose CT (LDCT) in Wenling, Zhejiang Province, we collected baseline and imaging information of high-risk groups for lung cancer who underwent LDCT screening from April 2019 to October 2021 and patients with previous history of lung cancer, tuberculosis, pneumoconiosis, and silicosis were excluded. A total of 28 539 study subjects were included in the analysis, and the follow-up ended on 31 December 2023. Based on the characteristics of the detected pulmonary nodules, the study subjects were classified with no nodules, with solid nodules, with pure ground glass nodules, and with part solid nodules groups. The association between different characteristics of lung nodules and the risk of lung cancer development was analyzed using the Cox proportional hazard regression model with a new diagnosis of lung cancer during the follow-up period as the outcome. Results The overall detection rate of lung nodules with a mean diameter of ≥3 mm was 76.5%, of which 53.7%, 18.2%, and 4.6% were detected in the solid nodule, pure ground glass nodule, and partially solid nodule groups, respectively. There were statistically significant differences between the different nodule groups in terms of age, gender, BMI, history of toxic exposure education level, smoking status, history of lung disease, and family history of lung cancer (all P<0.05). The median follow-up time of the study population was 3.4 years, and 485 new lung cancer cases were diagnosed during the follow-up period. After adjusting for covariates, the results of multifactorial Cox proportional hazard regression model analysis showed that the risk of lung cancer was higher in pure ground glass nodules and part solid nodules compared with solid nodules, with HR values (95%CI) of 1.89 (1.52-2.35) and 6.49 (5.18-8.14), respectively. The results of subgroup analysis showed that patients in the group of part solid nodules had the highest risk of lung cancer in all strata of the population, followed by patients with pure ground glass nodules. Patients in the solid nodule group who were older or had previous lung disease had a higher risk of lung cancer, and the risk of lung cancer in the part solid nodule group differed between genders. Conclusions The proportion of lung nodules detected is high in the high-risk group of lung cancer, and among them, patients with pure ground glass and part solid nodules have a higher risk of developing lung cancer. Attention should be paid to the annual follow-up management for patients with solid nodules who are older or who have had lung diseases, as well as for female patients with part solid nodules. |
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