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Wang H, Xie J, Chen Y, Jin J, Zhang M, Tung T, Xu Y. Gender-specific outcomes of low-dose computed tomography screening for lung cancer detection: A retrospective study in Chinese never-smoker population. Cancer Med 2024; 13:e70184. [PMID: 39342623 DOI: 10.1002/cam4.70184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/14/2024] [Accepted: 08/21/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Low-dose computed tomography (LDCT) has emerged as a pivotal tool for detecting lung cancer among ever-smokers. This study aims to evaluate the gender-specific outcomes of LDCT screening within the Chinese never-smoking population. METHODS We conducted a single-center, retrospective cohort study, which analyzed LDCT screening outcomes for 42,018 asymptomatic participants. Specifically, we focused on assessing gender-specific differences in the prevalence of pulmonary nodules, and the incidence of lung cancer diagnosis among never-smokers. RESULTS Among the 42,018 eligible participants, 41.50% were females and 58.50% were males. Most participants were non-smokers (77.57%), with a significantly higher proportion of non-smokers among females than males (99.33% vs. 62.14%). Pulmonary nodules were identified in 2.66% of participants, with a higher prevalence in females (2.99%) than males (2.43%) (p < 0.001). Non-smoking females had a higher incidence of positive nodules than non-smoking males (2.98% vs. 2.38%, p < 0.001). Invasive biopsies were performed in 334 individuals with nodules, confirming lung cancer in 258 cases. The majority of these cancer cases were non-smokers (212), with non-smoking females showing a higher incidence (0.85%) compared to males (0.43%) (p < 0.001). There was no significant difference in the false-positive rates between non-smoking females (0.14%) and males (0.13%). Multivariate analysis showed that never-smoking women were more likely to undergo biopsies (OR 1.65, p = 0.0016) and had a higher, though not statistically significant, probability of lung cancer diagnosis (OR 1.84, p = 0.06). CONCLUSION This study elucidates sex-based differences within the Chinese population, revealing a higher prevalence of pulmonary nodules and lung cancers among non-smoking females. These findings offer valuable reference for both clinical practice and future research initiatives.
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Affiliation(s)
- Huihong Wang
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jicheng Xie
- Department of radiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yahong Chen
- Health Management Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Meixian Zhang
- Public Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - TaoHsin Tung
- Public Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Youzu Xu
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
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Ruan GT, Wei YP, Ge YZ, Liu LS, Zhou ZY, Siddiqi SM, He QQ, Li SQ, Xu JF, Song Y, Zhang Q, Zhang X, Yang M, Chen P, Sun Y, Wang XB, Wang BY, Shi HP. Poor sleep quality association with higher lung cancer risk: a nested case-control study. PeerJ 2023; 11:e16540. [PMID: 38111660 PMCID: PMC10726752 DOI: 10.7717/peerj.16540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023] Open
Abstract
Background Little is known about the relationship between sleep quality and lung cancer incidence. Thus, this study was conducted to investigate the potential connection between sleep quality and lung cancer incidence. Methods We performed and selected a nested case-control study that included 150 lung cancer cases and 150 matched controls based on the Lianyungang cohort. Univariate and multivariate logistic regression was utilized to investigate the connection between potential risk factors and lung cancer incidence risk. Results In this study, the average age of participants was 66.5 ± 9.1 years, with 58.7% being male, and 52.7% reportedly experiencing sleep quality problems. The results of multivariate logistic regression showed that poor sleep quality was connected to an increased lung cancer incidence risk (P = 0.033, odds ratio = 1.83, 95% confidence interval = [1.05-3.19]) compared with those with good sleep quality. The stratified analyses showed a significantly positive connection between poor sleep quality (vs. good sleep quality) and cancer risk in smokers (vs. non-smoker, P for interaction = 0.085). The combined effect analysis indicated that smokers with poor sleep quality suffered from a 2.79-fold increase in cancer incidence rates when compared with non-smokers with good sleep quality. Conclusions Poor sleep quality was positively connected to an increased lung cancer incidence risk. In addition, among those individuals with poor sleep quality, smoking increased the lung cancer incidence risk.
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Affiliation(s)
- Guo-Tian Ruan
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ya-Ping Wei
- College of Public Health, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yi-Zhong Ge
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Li-Shun Liu
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Zi-Yi Zhou
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | | | - Qiang-Qiang He
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Shu-Qun Li
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Jia-Feng Xu
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Yun Song
- AUSA Research Institute, Shenzhen AUSA Pharmed Co Ltd, Shenzhen, China
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Qi Zhang
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming Yang
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ping Chen
- Inspection and Testing Center, Key Laboratory of Cancer FSMP for State Market Regulation, Shenzhen, China
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Yong Sun
- The First People’s Hospital of Lianyungang City, the First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Xiao-Bin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Bin-Yan Wang
- Shenzhen Evergreen Medical Institute, Shenzhen, China
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Han-Ping Shi
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Liu L, Wang F, Nan Y, Zou X, Jiang D, Wang Z. Diagnostic value of circulating miRNA in the benign and malignant lung nodules: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35857. [PMID: 37986348 PMCID: PMC10659640 DOI: 10.1097/md.0000000000035857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of death worldwide, and its diagnosis remains a significant challenge. Identifying effective methods to differentiate benign from malignant lung nodules is of paramount importance. This meta-analysis aimed to evaluate the clinical utility of circulating microRNAs (miRNAs) for the differential diagnosis of benign and malignant lung nodules. METHODS This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was conducted across 4 electronic databases, without any temporal restrictions. The inclusion and exclusion criteria were strictly applied to assess the clinical applications of circulating miRNAs. A robust and transparent quality assessment was performed using the quality assessment of diagnostic accuracy studies-2 tool, and rigorous statistical analyses were conducted to synthesize the various diagnostic measures. RESULTS In the meta-analysis of 11 studies, quality assessment of diagnostic accuracy studies-2 assessment revealed < 5% high-risk methodologies, ensuring robustness. Sensitivity and Specificity were consolidated at 0.83 (95% confidence interval [CI]: 0.72-0.90) and 0.81 (95% CI: 0.73-0.88), respectively. The positive likelihood ratio and negative likelihood ratio were 4.45 (95% CI: 3.03-6.54) and 0.21 (95% CI: 0.12-0.35), respectively. The diagnostic odds ratio was 21.31 (95% CI: 10.25-44.30) and area under the receiver operating characteristic curve was 0.89 (95% CI: 0.86-0.91). Subgroup analysis highlighted significant variations in diagnostic accuracy by ethnicity and miRNA source, with non-Asian populations and serum-based tests showing higher diagnostic accuracy. CONCLUSION This meta-analysis demonstrated that circulating miRNAs hold substantial diagnostic value in distinguishing between benign and malignant lung nodules.
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Affiliation(s)
- Li Liu
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Fei Wang
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Yan Nan
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Xiaozhao Zou
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Dan Jiang
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Zhong Wang
- General Practice Department, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
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Hong Z, Cui B, Bai X, Li H, Cheng T, Sheng Y, Lu Y, Wu X, Jin D, Zhao J, Gou Y. Meta analysis of the diagnostic value of circulating miRNA in benign and malignant pulmonary nodules. World J Surg Oncol 2023; 21:284. [PMID: 37689670 PMCID: PMC10492278 DOI: 10.1186/s12957-023-03133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/02/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVE A meta-analysis was conducted to assess the impact of miRNAs in circulation on diagnosing benign and malignant pulmonary nodules (BPNs and MPNs). METHODS Electronic databases such as Embase, PubMed, Web of Science, and The Cochrane Library were utilized for diagnostic tests of circulating miRNAs to diagnose BPNs and MPNs from the library creation to February 2023. Meta-analysis of the included literature was performed using Stata 16, Meta-Disc 1.4, and Review Manager 5.4 software. This study determined the combined sensitivity, specificity, diagnostic ratio (DOR), positive/negative likelihood ratios (PLR/NLR), as well as value of area under the receiver operating characteristic (ROC) curve. RESULTS This meta-analysis included 14 publications and 17 studies. According to our findings, the pooled sensitivity for miRNA in diagnosing benign and malignant pulmonary nodules was 0.82 [95% CI (0.74, 0.88)], specificity was 0.84 [95% CI (0.79, 0.88)], whereas the DOR was 22.69 [95% CI (13.87, 37.13)], PLR was 5.00 [95% CI (3.87, 6.46)], NLR was 0.22 [95% CI (0.15, 0.32)], and the area under the working characteristic curve (AUC) of the subject was 0.89 [95% CI (0.86, 0.91)]. CONCLUSION Circulating miRNAs could be used with sensitivity, specificity, DOR, PLR, NLR, and AUC as biomarkers to diagnose pulmonary nodules (PNs). However, more research is needed to determine the optimum miRNA combinations for diagnosing PNs due to the significant heterogeneity on previous studies.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xiangdou Bai
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Hongchao Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yannan Sheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jing Zhao
- Lanzhou First People's Hospital, Lanzhou, China.
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
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Su Z, Li X, Wu H, Meng Z, Li Y, Pan H, Liang H, Wang Y, Zhao FH, Qiao Y, Zhou Q, Fan YG. The impact of low-dose CT on smoking behavior among non-smokers, former-smokers, and smokers: A population-based screening cohort in rural China. Cancer Med 2023; 12:4667-4678. [PMID: 35894767 PMCID: PMC9972152 DOI: 10.1002/cam4.5073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/14/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer screening may provide a "teachable moment" for the smoking cessation and relapse prevention. However, the impact of lung cancer screening on smoking initiation in non-smokers has not been reported. METHODS A baseline smoking behavior survey was conducted in 2000 participants who were screened by low-dose computed tomography (LDCT) from 2014 to 2018. All participants were re-surveyed on their smoking behavior in 2019. Of these, 312 participants were excluded, leaving 1688 participants in the final analysis. The smoking initiation rate in baseline non-smokers, the relapse rate in baseline former smokers, and the abstinence rate in baseline current smokers were calculated, respectively. The associations between screening results, demographic characteristics, and smoking behavior change were analyzed using multivariable logistic regression. RESULTS From 2014 to 2019, smoking prevalence significantly decreased from 52.6% to 49.1%. The prevalence of smoking initiation, relapse, and abstinence in baseline non-smokers, former, and current smokers was 16.8%, 22.9%, and 23.7%, respectively. The risk of smoking initiation in baseline non-smokers was significantly higher in those with negative screening result (adjusted OR = 2.97, 95% CI: 1.27-6.94). Compared to smokers who only received baseline screening, the chance of smoking abstinence in baseline current smokers was reduced by over 80% in those who attended 5 rounds of screening (adjusted OR = 0.15, 95% CI:0.08-0.27). No significant associations were found between smoking relapse and prior screening frequency, with at least one positive screening result. Age, gender, occupational exposure, income, and smoking pack years were also associated with smoking behavior changes. CONCLUSIONS The overall decreased smoking prevalence indicated an overwhelming effect of "teachable moment" on "license to smoke." A tailored smoking cessation strategy should be integrated into lung cancer screening.
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Affiliation(s)
- Zheng Su
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuebing Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Wu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongli Pan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao Liang
- Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Chengdu, Sichuan University, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Center of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Chengdu, Sichuan University, China
| | - Ya-Guang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Ma A, Wang G, Du Y, Guo W, Guo J, Hu Y, Bai D, Huang H, Zhuang L, Chen J, Liu Q. The clinical relevance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic obstructive pulmonary disease with lung cancer. Front Oncol 2022; 12:902955. [PMID: 36237340 PMCID: PMC9552820 DOI: 10.3389/fonc.2022.902955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChronic obstructive pulmonary disease (COPD) coexisting with lung cancer is associated with severe mortality and a worse prognosis. Inflammation plays an important role in common pathogenic pathways and disease progression. However, a few studies have identified the clinical value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in COPD with lung cancer, which are systemic inflammatory response markers in the blood. This study aimed to determine the association of the NLR or PLR with clinical characteristics and whether NLR or PLR can be diagnostic markers for COPD with lung cancer.MethodsBetween 2015 and 2021, we conducted a retrospective analysis of 236 COPD patients with lung cancer and 500 patients without lung cancer (control group). Clinical information, blood routine examination, and spirometry results were collected and analyzed. The receiver operating characteristic (ROC) curve was used to identify the best cutoff point of NLR or PLR. Multivariate logistic regression analysis was performed to evaluate the association of NLR or PLR with the diagnosis and prognosis of COPD with lung cancer.ResultsCompared to patients in the COPD-only group, patients in the lung cancer group had a higher percentage of current smoking and emphysema, and it was found that NLR or PLR was significantly higher in the lung cancer group. Multivariate analysis showed that age, smoking status, FEV1%pred, emphysema, NLR, and PLR were independent risk factors for lung cancer development in COPD. Furthermore, the high level of NLR or PLR was associated with age over 70 years old, current smoking status, and ineligible surgery treatment. The level of PLR or NLR markedly increased with hypercoagulation status, the severity of airflow limitation, and advanced progression of lung cancer. Additionally, the ROC analysis also revealed that elevated NLR or PLR was an independent predictor of COPD in lung cancer patients, TNM stages IIIB–IV at first diagnosis in lung cancer, and ineligible surgery in lung cancer patients.ConclusionIncreased NLR or PLR values might be an important and easily measurable inflammation biomarker to predict the diagnosis and severity of lung cancer with COPD.
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Affiliation(s)
- Aiping Ma
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Guangdong Wang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yan Du
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Weixi Guo
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxi Guo
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yi Hu
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Dongyu Bai
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Huiping Huang
- Department of Infection Control, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Lianjin Zhuang
- Division of Quality Management, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jinhan Chen
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Qun Liu, ; Jinhan Chen,
| | - Qun Liu
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Qun Liu, ; Jinhan Chen,
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Li H, Zhao M, Fei G, Wang Z, Wang S, Wei P, Li W. Epidemiological trends and incidence prediction of lung cancer in China based on the Global Burden of Disease study 2019. Front Med (Lausanne) 2022; 9:969487. [PMID: 36203776 PMCID: PMC9530458 DOI: 10.3389/fmed.2022.969487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Lung cancer remains the most common malignancy in China. This study aims to provide scientific support for the prevention and treatment of lung cancer by analyzing the epidemiological trends of lung cancer in China from 1990 to 2019. Based on the global health exchange database (GHDx), joinpoint and age-period-cohort analyses were performed to explore the trend of lung cancer incidence and mortality rates from 1990 to 2019. According to incidence rates from 1990 to 2019, a model was constructed to predict the incidence rates in the next 5 years. In addition, changes in risk factors associated with lung cancer deaths were compared between 1990 and 2019 and between males and females in 2019. The results are as follows. The age-standardized incidence rates (ASIRs), and age-standardized death rates (ASDRs) of lung cancer among Chinese had overall upward trends from 1990 to 2019. The ASDRs of females and males in China decreased since 2010. Interestingly, from 2016 to 2019, the ASIRs and ASDRs of females rose significantly. The age-period-cohort model showed that the incidence and mortality rates of lung cancer in China increased with age, and the growth rate accelerated after 45 years old. After 2004, the relative risks of lung cancer incidence increased with the passage of the period. Also, after the 1950-1954 birth cohort, the risks of lung cancer incidence and death began to decrease. The autoregressive integrated moving average (ARIMA) model predicted that the incidence rates of lung cancer in China would continue to rise in the next 5 years. The top five risk factors for lung cancer deaths of both genders in 2019 were smoking, ambient particulate matter pollution, secondhand smoke, high fasting plasma glucose, and household air pollution from solid fuels. The above results provided precise clues for the prevention and treatment of lung cancer in China.
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Affiliation(s)
- Han Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Meng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Gaoqiang Fei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Zemin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Shuai Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Wei Li
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, China
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8
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Liang D, Shi J, Li D, Wu S, Jin J, He Y. Participation and Yield of a Lung Cancer Screening Program in Hebei, China. Front Oncol 2022; 11:795528. [PMID: 35083151 PMCID: PMC8784378 DOI: 10.3389/fonc.2021.795528] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Lung cancer screening has been widely conducted in Western countries. However, population-based lung cancer screening programs in Hebei in China are sparse. Our study aimed to assess the participation rate and detection rate of positive nodules and lung cancer in Hebei province. METHOD In total, 228 891 eligible participants aged 40-74 years were enrolled in the Cancer Screening Program in Hebei from 2013 to 2019. A total of 54 846 participants were evaluated as the lung cancer high-risk population by a risk score system which basically followed the Harvard Risk Index and was adjusted for the characteristics of the Chinese population. Then this high-risk population was recommended for low-dose computed tomography (LDCT) screening. And all participants attended annual passive follow-up, and the active follow-up interval was based on radiologist's suggestion. All participants were followed-up until December 31, 2020. The overall, group-specific participation rates were calculated, and its associated factors were analyzed by a multivariable logistic regression model. Participation rates and detection of positive nodules and lung cancer were reported. RESULTS The overall participation rate was 52.69%, where 28 899 participants undertook LDCT screening as recommended. The multivariable logistic regression model demonstrated that a high level of education, having disease history, and occupational exposure were found to be associated with the participation in LDCT screening. The median follow-up time was 3.56 person-years. Overall, the positive identification of lung nodules and suspected lung cancer were 12.73% and 1.46% through LDCT screening. After the native and passive follow-up, 257 lung cancer cases were diagnosed by lung cancer screening, and the detection rate of lung cancer was 0.89% in the screening group. And its incidence density was 298.72 per 100,000. Positive lung nodule rate and detection rate were increased with age. CONCLUSION Our study identified personal and epidemiological factors that could affect the participation rate. Our findings could provide the guideline for precise prevention and control of lung cancer in the future.
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Affiliation(s)
- Di Liang
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jin Shi
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Daojuan Li
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Siqi Wu
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Jin
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yutong He
- Cancer Institute in Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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9
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Cui X, Zheng S, Heuvelmans MA, Du Y, Sidorenkov G, Fan S, Li Y, Xie Y, Zhu Z, Dorrius MD, Zhao Y, Veldhuis RNJ, de Bock GH, Oudkerk M, van Ooijen PMA, Vliegenthart R, Ye Z. Performance of a deep learning-based lung nodule detection system as an alternative reader in a Chinese lung cancer screening program. Eur J Radiol 2021; 146:110068. [PMID: 34871936 DOI: 10.1016/j.ejrad.2021.110068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the performance of a deep learning-based computer-aided detection (DL-CAD) system in a Chinese low-dose CT (LDCT) lung cancer screening program. MATERIALS AND METHODS One-hundred-and-eighty individuals with a lung nodule on their baseline LDCT lung cancer screening scan were randomly mixed with screenees without nodules in a 1:1 ratio (total: 360 individuals). All scans were assessed by double reading and subsequently processed by an academic DL-CAD system. The findings of double reading and the DL-CAD system were then evaluated by two senior radiologists to derive the reference standard. The detection performance was evaluated by the Free Response Operating Characteristic curve, sensitivity and false-positive (FP) rate. The senior radiologists categorized nodules according to nodule diameter, type (solid, part-solid, non-solid) and Lung-RADS. RESULTS The reference standard consisted of 262 nodules ≥ 4 mm in 196 individuals; 359 findings were considered false positives. The DL-CAD system achieved a sensitivity of 90.1% with 1.0 FP/scan for detection of lung nodules regardless of size or type, whereas double reading had a sensitivity of 76.0% with 0.04 FP/scan (P = 0.001). The sensitivity for detection of nodules ≥ 4 - ≤ 6 mm was significantly higher with DL-CAD than with double reading (86.3% vs. 58.9% respectively; P = 0.001). Sixty-three nodules were only identified by the DL-CAD system, and 27 nodules only found by double reading. The DL-CAD system reached similar performance compared to double reading in Lung-RADS 3 (94.3% vs. 90.0%, P = 0.549) and Lung-RADS 4 nodules (100.0% vs. 97.0%, P = 1.000), but showed a higher sensitivity in Lung-RADS 2 (86.2% vs. 65.4%, P < 0.001). CONCLUSIONS The DL-CAD system can accurately detect pulmonary nodules on LDCT, with an acceptable false-positive rate of 1 nodule per scan and has higher detection performance than double reading. This DL-CAD system may assist radiologists in nodule detection in LDCT lung cancer screening.
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Affiliation(s)
- Xiaonan Cui
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Sunyi Zheng
- Westlake University, Artificial Intelligence and Biomedical Image Analysis Lab, School of Engineering, Hangzhou, People's Republic of China; Institute of Advanced Technology, Westlake Institute for Advanced Study, Hangzhou, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Yihui Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Shuxuan Fan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Yanju Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Yongsheng Xie
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Zhongyuan Zhu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Yingru Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Raymond N J Veldhuis
- University of Twente, Faculty of Electrical Engineering Mathematics and Computer Science, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Matthijs Oudkerk
- University of Groningen, Faculty of Medical Sciences, the Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Machine Learning Lab, Data Science Center in Health, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Zhaoxiang Ye
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China.
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10
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Li J, Hu P, Shi J, Fan Y, Ren J, Chen H, Li N, Liao X, Liu Y, Du L, Wu N, Tang W, Zhang Y, Zou S, Pinsky P, Prorok P, Fagerstrom R, Taylor M, Kramer B, Dai M, He J. Results of the cancer screening feasibility study in China: a multicentered randomized controlled trial of lung and colorectal cancer screening. JOURNAL OF THE NATIONAL CANCER CENTER 2021; 1:132-138. [PMID: 39036801 PMCID: PMC11256538 DOI: 10.1016/j.jncc.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background To provide an understanding of important aspects of the participant recruitment and data collection, become aware of any potential problems, and obtain necessary information in order to design a large-scale randomized controlled trial (RCT) for lung cancer and colorectal cancer (CRC) screening in China. Methods This feasibility study was a multicentered, open-label, pilot randomized trial. A total of 2696 participants who were at high risk of lung cancer were recruited from three screening centers and randomly allocated to arm 1 (n = 894), annual low-dose computed tomography (LDCT) plus a baseline colonoscopy; arm 2 (n = 902), biennial LDCT plus annual fecal immunochemical test (FIT) with OC-Sensor (OC-FIT); and arm 3 (n = 900), annual Insure-FIT plus Septin 9 blood test. Information on randomization, compliance, positivity rate, cancer case detection, and contamination with screening for lung cancer and CRC were collected. Results Participant characteristics were similar across study arms. The compliance rate of annual LDCT screening in arm 1 was 86.4% (95% CI: 83.9%, 88.5%) at baseline (T0), and 69.0% (95% CI: 65.8%, 72.0%) and 70.7% (95% CI: 67.6%, 73.7%) at the following two rounds (T1 and T2). The compliance rates of biennial LDCT screening in arm 2 were similar to those in arm 1 in the corresponding rounds. The compliance rate was 55.5% (95% CI: 52.2%, 58.8%) for colonoscopy in arm 1, while the compliance rates of OC-FIT, Insure-FIT, and the Septin 9 test in arms 2 and 3 were all approximately 90% at T0, decreasing to 65%-80% at T1 and T2. The positivity rate, cancer case detection rate, and contamination rate of screening for lung cancer and CRC were also reported. Conclusion In this pilot study, the feasibility of an RCT in China of lung cancer and CRC screening was demonstrated.
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Affiliation(s)
- Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Hu
- National Cancer Institute, Bethesda, USA
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaguang Fan
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongda Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Yuqin Liu
- Gansu Cancer Hospital, Lanzhou, China
| | - Lingbin Du
- Zhejiang Cancer Hospital, Hangzhou, China
| | - Ning Wu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Tang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yueming Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuangmei Zou
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | - Min Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - China Cancer Screening Trial Feasibility Study Group
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Cancer Institute, Bethesda, USA
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Hunan Cancer Hospital, Changsha, China
- Gansu Cancer Hospital, Lanzhou, China
- Zhejiang Cancer Hospital, Hangzhou, China
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11
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Lin Y, Ma J, Wu M, Zhou H, Lu Y, Cen Y, Yuan Z, Mei Z, Huang Y, Zhou Y. [Cancer Screening Program in Urban Kunming of Yunnan: Evaluation of Lung Cancer Risk Assessment and Screening]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:541-546. [PMID: 32702787 PMCID: PMC7406440 DOI: 10.3779/j.issn.1009-3419.2020.101.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung cancer is the most common neoplasmas with a poor prognosis and a low 5-year survival rate. Early screening is an important measure for the prevention and treatment of lung cancer. At present, different countries have issued corresponding lung cancer screening guidelines, but China still lacks guidelines based on Chinese population research. Therefore, the National Cancer Center launched a Multi-center Cancer Screening Program in Urban China. This study analyzed the evaluation of lung cancer risk assessment model and screening effect in urban China of Yunnan, so as to explore the evaluation model of high-risk lung cancer population suitable for China's national conditions and develop lung cancer screening guidelines for Chinese. METHODS A questionnaire survey and lung cancer risk assessment were conducted on 165,337 people in 36 street offices in 4 main urban areas of Kunming, Yunnan Province, using cluster sampling method from January 2015 to December 2019. People with high-risk of lung cancer conducted low-dose computed tomography (LDCT) screening of chest. What's more, all participants were followed up by active or passive follow-up. RESULTS There were 264 patients were diagnosed lung cancer by pathology, and the overall incidence of lung cancer was 0.16% (264/165,337). The high-risk group (0.31%, 116/37,914) was higher than the non-high-risk group (0.12%, 148/127,423), and the difference was statistically significant (P<0.001). The incidence of lung cancer in the high-risk group was higher than the non-high-risk group among the male, female, and lower 50-year-old or more than 50-year-old subgroups, with statistical differences (P<0.001), but there was no statistical difference in the group without LDCT screening (P=0.73). The sensitivity of the lung cancer high-risk population assessment model was 43.94% (116/264) and the specificity was 77.10% (127,275/165,073). The early diagnosis rate of the screening group was 72.97% (54/74), which was significantly higher than that of the non-screening group [28.48% (43/151)]. CONCLUSIONS The lung cancer high-risk population assessment model of National Key Public Health Program: Cancer Screening Program in Urban China can detect high-risk populations and improve the early diagnosis rate of lung cancer effectively.
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Affiliation(s)
- Yanping Lin
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Jie Ma
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Meng Wu
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Hai Zhou
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Yanni Lu
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Yongcun Cen
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Zhongqin Yuan
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Zechao Mei
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Yunchao Huang
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Yongchun Zhou
- Department of Yunnan Cancer Center, Yunnan Cancer Center/Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
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12
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Abstract
The increasing use of low-dose CT for screening for lung cancer will inevitably identify many small, asymptomatic lung nodules and ground-glass opacities (GGOs). Current guidelines for the management of screening-detected lesions tend to advise a conservative approach based on serial imaging and intervention only if ‘suspicious’ features emerge. However, more recent developments in thoracic surgery and in the understanding of the screening-detected lesions themselves prompt some pertinent questions over this conservatism. Is CT surveillance sufficiently reliable to exclude malignancy? Is it really necessary to hold back on operative biopsy and resection given modern surgical safety and efficacy? Is the option for early surgical therapy a viable one—especially with the availability of sublobar resection today? Modern data suggests that the risk of inaction for some screening-detected lesions may be higher than expected, whereas the potential harm of surgical intervention may be substantially reduced by sublobar resection and the latest minimally invasive surgical techniques. A more pro-active approach towards offering surgery for screening-detected lesions should now be considered.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong, China.,International Medical Centre, Hong Kong, China
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13
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Computed Tomography Screening for Early Lung Cancer, COPD and Cardiovascular Disease in Shanghai: Rationale and Design of a Population-based Comparative Study. Acad Radiol 2021; 28:36-45. [PMID: 32151538 DOI: 10.1016/j.acra.2020.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To describe the rational and design of a population-based comparative study. The objective of the study is to assess the screening performance of volume-based management of CT-detected lung nodule in comparison to diameter-based management, and to improve the effectiveness of CT screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), in addition to lung cancer, based on quantitative measurement of CT imaging biomarkers in a Chinese screening setting. MATERIALS AND METHODS A population-based comparative study is being performed, including 10,000 asymptomatic participants between 40 and 74 years old from Shanghai urban population. Participants in the intervention group undergo a low-dose chest and cardiac CT scan at baseline and 1 year later, and are managed according to NELCIN-B3 protocol. Participants in the control group undergo a low-dose chest CT scan according to the routine CT protocol and are managed according to the clinical practice. Epidemiological data are collected through questionnaires. In the fourth year from baseline, the diagnosis of the three diseases will be collected. RESULTS The unnecessary referral rate will be compared between NELCIN-B3 and standard protocol for managing early-detected lung nodules. The effectiveness of quantitative measurement of CT imaging biomarkers for early detection of lung cancer, COPD and CVD will be evaluated. CONCLUSION We expect that the quantitative assessment of the CT imaging biomarkers will reduce the number of unnecessary referrals for early detected lung nodules, and will improve the early detection of COPD and CVD in a Chinese urban population. TRIAL REGISTRATION ClinicalTrials.gov, NCT03988322. Registered on 14 June 2019.
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14
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The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries. NATURE CANCER 2020; 1:1140-1152. [PMID: 35121933 DOI: 10.1038/s43018-020-00142-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.
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15
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韦 梦, 乔 友. [Progress of Lung Cancer Screening with Low Dose Helical Computed Tomography]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:875-882. [PMID: 32791651 PMCID: PMC7583869 DOI: 10.3779/j.issn.1009-3419.2020.101.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/19/2022]
Abstract
Lung cancer which represents characteristics of a heavy disease burden, a large proportion of advanced lung cancer and a low five-year survival rate is a threat to human health. It is essential to implement population-based lung cancer screening to improve early detection and early treatment. The National Lung Screening Trial (NLST) demonstrated that screening with low dose helical computed tomography (LDCT) may decrease lung cancer mortality, which brings hope for the early diagnosis and treatment of lung cancer. In recent years, great progresses have been made on research of lung cancer screening with LDCT. However, whether LDCT could be applied to large population-based lung cancer screening projects is still under debate. In this paper, we review the recent progresses on history of lung cancer screening with LDCT, selection of high-risk individuals, management of pulmonary nodules, performance of screening, acceptance of LDCT and cost-effectiveness.
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Affiliation(s)
- 梦娜 韦
- />100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院流行病学室Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 友林 乔
- />100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院流行病学室Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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16
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Association of cancer screening and residing in a coal-polluted East Asian region with overall survival of lung cancer patients: a retrospective cohort study. Sci Rep 2020; 10:17432. [PMID: 33060705 PMCID: PMC7566617 DOI: 10.1038/s41598-020-74082-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/23/2020] [Indexed: 11/08/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide. The Xuanwei-Fuyuan (XF) region of Yunnan, China has a high incidence of lung cancer from coal-related pollution. Effort to raise public awareness screening for lung cancer has been ongoing. We retrospectively analyzed overall survival (OS) of lung cancer patients of a tertiary cancer center in Yunnan to investigate screening and regional residential status as predictive factors. Consecutive cases of newly diagnosed lung cancer were reviewed. The lung cancer cases diagnosed by screening were more likely to be early-staged and treated by surgery than those diagnosed not by screening. In patients diagnosed not by screening, XF residential status was a significant predictor of improved OS. Frailty model detected significant heterogeneity associated with region of residence in unscreened patients. Potential biases associated with screening were examined by Monte Carlo simulations and sensitivity analyses. Focused effort in cancer screening and increased public awareness of pollution-related lung cancer in XF might have led to early diagnosis and improved OS, and increased investment in health care resources in high risk areas may have produced additional unobserved factors that underlay the association of XF residential status with improved OS in patients diagnosed not by screening.
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17
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Lung cancer LDCT screening and mortality reduction - evidence, pitfalls and future perspectives. Nat Rev Clin Oncol 2020; 18:135-151. [PMID: 33046839 DOI: 10.1038/s41571-020-00432-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
In the past decade, the introduction of molecularly targeted agents and immune-checkpoint inhibitors has led to improved survival outcomes for patients with advanced-stage lung cancer; however, this disease remains the leading cause of cancer-related mortality worldwide. Two large randomized controlled trials of low-dose CT (LDCT)-based lung cancer screening in high-risk populations - the US National Lung Screening Trial (NLST) and NELSON - have provided evidence of a statistically significant mortality reduction in patients. LDCT-based screening programmes for individuals at a high risk of lung cancer have already been implemented in the USA. Furthermore, implementation programmes are currently underway in the UK following the success of the UK Lung Cancer Screening (UKLS) trial, which included the Liverpool Health Lung Project, Manchester Lung Health Check, the Lung Screen Uptake Trial, the West London Lung Cancer Screening pilot and the Yorkshire Lung Screening trial. In this Review, we focus on the current evidence on LDCT-based lung cancer screening and discuss the clinical developments in high-risk populations worldwide; additionally, we address aspects such as cost-effectiveness. We present a framework to define the scope of future implementation research on lung cancer screening programmes referred to as Screening Planning and Implementation RAtionale for Lung cancer (SPIRAL).
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18
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Qin Y, Xu Y, Ma D, Tian Z, Huang C, Zhou X, He J, Liu L, Guo C, Wang G, Zhang J, Wang Y, Liu H. Clinical characteristics of resected solitary ground-glass opacities: Comparison between benign and malignant nodules. Thorac Cancer 2020; 11:2767-2774. [PMID: 32844603 PMCID: PMC7529560 DOI: 10.1111/1759-7714.13575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The management of ground-glass opacities (GGOs) depends mainly on personal experience. In clinical practice, benign GGOs are not rare in resected specimens, for which operations may be avoided. We retrospectively compared the clinical features of resected GGOs to identify differential diagnostic characteristics. METHODS Among 1456 patients with suspected malignant GGOs who underwent surgical resection, 105 patients (35 with benign GGOs and 70 matched controls with malignant GGOs) were included. Clinical characteristics, including demographics and radiologic, surgical and pathologic characteristics, were collected. RESULTS The smoking index (P = 0.044), frequency of coughing (P = 0.026), GGO size (P = 0.003), size change during follow-up (P = 0.011), location (P = 0.022), presence of air bronchogram sign (P = 0.004), distance to the pleura (P = 0.021) and positron emission tomography/computed tomography (PET/CT) appearance (P = 0.003) showed significant differences between the benign and malignant groups. Pathologically, the resected benign GGOs included focal fibrosis (17), inflammation or infection (seven), lymphoproliferative disorder (one), hamartoma (three), inflammatory myofibroblastic tumor (two), hemangioma or vascular malformation (two), endometriosis (two) and pulmonary cyst (one). CONCLUSIONS A higher smoking index, coughing, larger size, similar or increased size during follow-up, location in the upper and middle lobes, air bronchogram sign on CT, lesion margin to pleura distance over 1 cm, and malignant tendency on PET/CT reports were associated with malignant GGOs. Relatively active surgical interventions could be considered for GGOs highly suspected of malignancy.
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Affiliation(s)
- Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhenhuan Tian
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yanqing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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19
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Liu D, Huang Y, Zhou Q, Liu L, Che G, Lu Y, Xu F, Luo F, Bai H, Li W. [Pulmonary Nodules/Lung Cancer Comprehensive Management Mode: Design and Application]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:299-305. [PMID: 32279474 PMCID: PMC7260385 DOI: 10.3779/j.issn.1009-3419.2020.103.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 早期筛查是有效降低肺癌死亡率的重要方式, 然而我国尚缺乏统一、有效的肺癌早期筛查标准与手段。本研究基于四川大学华西医院构建的肺结节/肺癌患者全程管理平台, 将肺结节早期筛查纳入肺癌规范诊疗体系, 以期实现提升肺癌患者生存率。 方法 建立三大研究队列:健康人群筛查队列、肺结节患者队列、肺癌患者队列, 系统、持续收集、分析各队列人群临床诊疗相关大数据。初步计划对肺结节早期筛查效果进行验证。 结果 该平台初步以2015年1月1日-2019年12月31日华西医院40岁以上职工2, 836人作为实施对象, 共诊断66例肺癌, 均经外科手术切除确诊为早期肺癌65例, 1例肺癌伴脑转移。 结论 肺结节/肺癌患者全程管理项目可实现肺结节高效筛查、随访与诊疗, 未来全程管理模式将全面覆盖华西医疗系统, 发挥区域带动作用。
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Affiliation(s)
- Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Huang
- Health Management Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - You Lu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Xu
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Luo
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hongli Bai
- Department of radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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20
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Wei MN, Su Z, Wang JN, Gonzalez Mendez MJ, Yu XY, Liang H, Zhou QH, Fan YG, Qiao YL. Performance of lung cancer screening with low-dose CT in Gejiu, Yunnan: A population-based, screening cohort study. Thorac Cancer 2020; 11:1224-1232. [PMID: 32196998 PMCID: PMC7180575 DOI: 10.1111/1759-7714.13379] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/05/2023] Open
Abstract
Background The performance of lung cancer screening with low‐dose computed tomography (CT) (LDCT) in China is uncertain. This study aimed to evaluate the performance of LDCT lung cancer screening in the Chinese setting. Methods In 2014, a screening cohort of lung cancer with LDCT was established in Gejiu, Yunnan Province, a screening center of the Lung Cancer Screening Program in Rural China (LungSPRC). Participants received a baseline screening and four rounds of annual screening with LDCT in two local hospitals until June 2019. We analyzed the rates of participation, detection, early detection, and the clinical characteristics of lung cancer. Results A total of 2006 participants had complete baseline screening results with a compliance rate of 98.4%. Of these, 1411 were high‐risk and 558 were nonhigh‐risk participants. During this period, 40 lung cancer cases were confirmed, of these, 35 were screen‐detected, four were post‐screening and one was an interval case. The positive rate of baseline and annual screening was 9.7% and 9.0%, while the lung cancer detection rate was 0.4% and 0.6%, respectively. The proportion of early lung cancer increased from 37.5% in T0 to 75.0% in T4. Adenocarcinoma was the most common histological subtype. Lung cancer incidence according to the criteria of LungSPRC and National Lung Cancer Screening Trial (NLST) was 513.31 and 877.41 per 100 000 person‐years, respectively. Conclusions The program of lung cancer screening with LDCT showed a successful performance in Gejiu, Yunnan. However, further studies are warranted to refine a high‐risk population who will benefit most from LDCT screening and reduce the high false positive results. Key points This study reports the results of lung cancer screening with LDCT in Gejiu, Yunnan, a high‐risk area of lung cancer, and it demonstrates that lung cancer screening with LDCT is effective in detecting early‐stage lung cancer. Our program provides an opportunity to explore the performance of LDCT lung cancer screening in the Chinese context.
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Affiliation(s)
- Meng-Na Wei
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Su
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Ning Wang
- Office of Gejiu Municipal Leading Group for Cancer Prevention and Control, Gejiu, China
| | | | - Xiao-Yun Yu
- Office of Gejiu Municipal Leading Group for Cancer Prevention and Control, Gejiu, China
| | - Hao Liang
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qing-Hua Zhou
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ya-Guang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Lin Y, Ma J, Feng J, Zhang Q, Huang Y. [Results of Lung Cancer Screening among Urban Residents in Kunming]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:413-418. [PMID: 31315779 PMCID: PMC6712263 DOI: 10.3779/j.issn.1009-3419.2019.07.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung cancer screening is an effective measure to reduce lung cancer mortality. Currently, lung cancer screening is recommended internationally and nationally. China had launched a large-scale early diagnosis and early treatment of rural and urban lung cancer in 2009 and 2012. Yunnan Province participated in related projects in 2009 and 2014, but the results of large-scale lung cancer screening have not been reported in Yunnan Province. In this study, we participated in the National Key Public Health Program, Cancer Screening Program in Urban China and analyzed the results of lung cancer screening in 10,154 urban residents in Kunming, Yunnan Province from 2014 to 2018, and evaluated the screening effect of early diagnosis and treatment of lung cancer in urban. METHODS A total of 31,824 people with high risk of lung cancer were evaluated with 40-74 year-old population in Kunming. A high-risk group underwent low-dose spiral computed tomography (CT) scan of the chest, and analyze the high risk rate and detection rate. A total of 150,535 questionnaires were completed in 5 years, and 31,824 people with high risk of lung cancer were evaluated. RESULTS The high-risk rate was 21.14%. A total of 10,154 low-dose spiral CT screenings were performed, with a participation rate of 31.91%. The detection rate of intrapulmonary nodules was 22.28% (2,262/10,154), of which the detection rate of <5 mm solid/partial solid nodules was 11.30% (1,332/10,154) and the detection rate of <8 mm non-solid nodules was 2.20% (219/10,154). The positive nodule detection rate was 7.00% (711/10,154), the suspected lung cancer detection rate was 0.60% (59/10,154), and the lung cancer detection rate was 0.27% (27/10,154). The detection rate of the positive nodules, <8 mm non-solid nodules and suspected lung cancer in male were significantly higher than that in female, and the positive nodules, <5 mm solid nodules, suspected lung cancer and confirmed lung cancer detection rate increased with age. CONCLUSIONS Low-dose spiral CT is suitable for screening of high-risk populations of lung cancer, which is helpful for early detection of positive nodules and related diseases in the lungs. It is necessary to pay attention to the screening of lung cancer in people over 60 years old. Understand the lung health status of residents in Kunming. Raise awareness of lung cancer prevention and treatment among residents, and improve the rate of early diagnosis and treatment of lung cancer.
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Affiliation(s)
- Yanping Lin
- Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Center, Kunming 650118, China
| | - Jie Ma
- Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Center, Kunming 650118, China
| | - Jun Feng
- Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Center, Kunming 650118, China
| | - Qiang Zhang
- Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Center, Kunming 650118, China
| | - Yunchao Huang
- Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Center, Kunming 650118, China
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22
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Yang D, Liu Y, Bai C, Wang X, Powell CA. Epidemiology of lung cancer and lung cancer screening programs in China and the United States. Cancer Lett 2019; 468:82-87. [PMID: 31600530 DOI: 10.1016/j.canlet.2019.10.009] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/27/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022]
Abstract
Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women.
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Affiliation(s)
- Dawei Yang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Zhongshan Hospital Institute for Clinical Science, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Engineering Research Center of AI Technology for Cardiopulmonary Disease, Shanghai, China
| | - Yang Liu
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of AI Technology for Cardiopulmonary Disease, Shanghai, China
| | - Xiandong Wang
- Zhongshan Hospital Institute for Clinical Science, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Engineering Research Center of AI Technology for Cardiopulmonary Disease, Shanghai, China.
| | - Charles A Powell
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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23
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Fan L, Wang Y, Zhou Y, Li Q, Yang W, Wang S, Shan F, Zhang X, Shi J, Chen W, Liu SY. Lung Cancer Screening with Low-Dose CT: Baseline Screening Results in Shanghai. Acad Radiol 2019; 26:1283-1291. [PMID: 30554839 DOI: 10.1016/j.acra.2018.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/22/2018] [Accepted: 12/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To report the initial baseline lung cancer screening results with low dose computed tomography (LDCT) in a multicenter study in Shanghai. METHODS A total of 14,506 subjects underwent LDCT lung cancer screening and completed questionnaires consisting of 13 risk factors for lung cancer in the prospective study. The positive result was defined as any size and density nodule. The nodules were classified into calcified, solid, part-solid, and nonsolid nodules. The positive rate and incidental detection rate of lung cancer and stage I lung cancer were calculated. The proportion of lung nodule and lung cancer with different density and size was analyzed. RESULTS The positive rate and incidental detection rate of lung cancer was 29.89% and 1.23%, respectively. The incidental detection rate of stage I lung cancer was 0.97%. The proportion of lung cancer in lung nodules and stage I in lung cancer was 3.48% and 81.09%, respectively. The ratio of nonsolid nodule, part-solid nodule, and solid nodule in lung cancer was 52.94%, 31.93%, and 15.13%, respectively. 74.88% lung nodules were less than 5 mm and 94.12% lung cancers were larger than 5mm in size. CONCLUSION The baseline LDCT lung cancer screening showed subsolid nodules accounted for the majority of lung cancer, and 5 mm in size would be recommended as the positive result threshold.
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24
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Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. LUNG CANCER (AUCKLAND, N.Z.) 2019; 10:107-124. [PMID: 31686936 PMCID: PMC6777900 DOI: 10.2147/lctt.s192643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Lung cancer remains the leading cause of cancer incidence and mortality worldwide. Approximately 60% of the world's new cases of lung cancer and deaths from it are expected in Asia in 2018. Currently, lung cancer screening using low-dose computed tomography (LDCT) is recommended for heavy smokers in North America, Europe and some countries in Asia. Tobacco smoking being the major risk factor for lung cancer, but in Asia, lung cancer in never-smokers (LCINS) is also a concern. This paper reviews on lung cancer incidence, mortality, etiology, smoking in Asia, and systematic reviews on LDCT lung cancer screening studies, including ongoing projects and recommendation on lung cancer screening in Asia. Some of the earliest studies of LDCT lung cancer screening worldwide were in Asia. Many countries in Asia have developed LDCT screening studies in various high-risk participants. Currently, there are several ongoing large-scale lung cancer screening trials to evaluate the efficacy of LDCT screening for never-smokers and light smokers, as well as heavy smokers, and to evaluate the feasibility of population-based LDCT lung cancer screening.
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Affiliation(s)
- Natthaya Triphuridet
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Chen Y, Watson TR, Criss SD, Eckel A, Palazzo L, Sheehan DF, Kong CY. A simulation study of the effect of lung cancer screening in China, Japan, Singapore, and South Korea. PLoS One 2019; 14:e0220610. [PMID: 31361789 PMCID: PMC6667161 DOI: 10.1371/journal.pone.0220610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/21/2019] [Indexed: 12/24/2022] Open
Abstract
More than 50% of the world's lung cancer cases occur in Asia and more than 20% of cancer deaths in Asia are attributable to lung cancer. The U.S. National Lung Screening Trial has shown that lung cancer screening with computed tomography (CT) can reduce lung cancer deaths. Using the Lung Cancer Policy Model-Asia (LCPM-Asia), we estimated the potential mortality reduction achievable through the implementation of CT-based lung cancer screening in China, Japan, Singapore, and South Korea. The LCPM-Asia was calibrated to the smoking prevalence of each of the aforementioned countries based on published national surveys and to lung cancer mortality rates from the World Health Organization. The calibrated LCPM-Asia was then used to simulate lung cancer deaths under screening and no-screening scenarios for the four countries. Using screening eligibility criteria recommended by the U.S. Centers for Medicare & Medicaid Services (CMS), which are based on age and smoking history, we estimated the lung cancer mortality reduction from screening through year 2040. By 2040, lung cancer screening would result in 91,362 life-years gained and 4.74% mortality reduction in South Korea; 290,325 life-years gained and 4.33% mortality reduction in Japan; 3,014,215 life-years gained and 4.22% mortality reduction in China; and 8,118 life-years gained and 3.76% mortality reduction in Singapore. As for mortality reduction by smoker type, current smokers would have the greatest mortality reduction in each country, ranging from 5.56% in Japan to 6.86% in Singapore. Among the four countries, lung cancer screening under CMS eligibility criteria was most effective in South Korea and least effective in Singapore. Singapore's low smoking prevalence and South Korea's aging population and higher smoking prevalence may partially explain the discrepancy in effectiveness. CT screening was shown to be promising as a means of reducing lung cancer mortality in the four countries.
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Affiliation(s)
- Yufan Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tina R. Watson
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Steven D. Criss
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Andrew Eckel
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lauren Palazzo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Deirdre F. Sheehan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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26
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Hao X, Qu T. Expression of CENPE and its Prognostic Role in Non-small Cell Lung Cancer. Open Med (Wars) 2019; 14:497-502. [PMID: 31259255 PMCID: PMC6592151 DOI: 10.1515/med-2019-0053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/06/2019] [Indexed: 01/04/2023] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is one of the most important causes of death worldwide. Most patients are diagnosed in the advanced stage and have a poor prognosis. This study was to investigate the expression and significance of CENPE in NSCLC. Method Collecting information about CENPE in the Oncoming database, and perform a further analysis of the data in the current database to conduct a meta-analysis for its functional role in NSCLC. Patient life cycle analysis using Kaplan-Meier Plotter and GEPIA databases are used to perform patient survival analysis. Result A total of 12 studies involved the expression of CENPE in NSCLC cancer tissues and normal tissues, including 1195 samples. CENPE was highly expressed in NSCLC cell carcinoma compared with the control group (P < 0.05). Moreover, the expression of CENPE was correlated with the overall survival rate of CENPE. The overall survival rate of patients with high expression of CENPE was poor, and the prognosis of patients with low expression of CENPE was better (P<0.05). Conclusion We propose high expression of CENPE in NSLCL tissue is related to the prognosis of NSCLC, which may provide important basis for the development of tumor drugs.
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Affiliation(s)
- Xuezhi Hao
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tao Qu
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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27
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Cheng YI, Davies MPA, Liu D, Li W, Field JK. Implementation planning for lung cancer screening in China. PRECISION CLINICAL MEDICINE 2019; 2:13-44. [PMID: 35694700 PMCID: PMC8985785 DOI: 10.1093/pcmedi/pbz002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 02/05/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in China, with over 690 000 lung cancer deaths estimated in 2018. The mortality has increased about five-fold from the mid-1970s to the 2000s. Lung cancer low-dose computerized tomography (LDCT) screening in smokers was shown to improve survival in the US National Lung Screening Trial, and more recently in the European NELSON trial. However, although the predominant risk factor, smoking contributes to a lower fraction of lung cancers in China than in the UK and USA. Therefore, it is necessary to establish Chinese-specific screening strategies. There have been 23 associated programmes completed or still ongoing in China since the 1980s, mainly after 2000; and one has recently been planned. Generally, their entry criteria are not smoking-stringent. Most of the Chinese programmes have reported preliminary results only, which demonstrated a different high-risk subpopulation of lung cancer in China. Evidence concerning LDCT screening implementation is based on results of randomized controlled trials outside China. LDCT screening programmes combining tobacco control would produce more benefits. Population recruitment (e.g. risk-based selection), screening protocol, nodule management and cost-effectiveness are discussed in detail. In China, the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed, as all the risk parameters have not as yet been determined. Although evidence on best practice for implementation of lung cancer screening has been accumulating in other countries, further research in China is urgently required, as China is now facing a lung cancer epidemic.
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Affiliation(s)
- Yue I Cheng
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Michael P A Davies
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - John K Field
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
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Shi JF, Wang L, Wu N, Li JL, Hui ZG, Liu SM, Yang BY, Gao SG, Ren JS, Huang HY, Zhu J, Liu CC, Fan JH, Zhao SJ, Xing PY, Zhang Y, Li N, Lei WD, Wang DB, Huang YC, Liao XZ, Xing XJ, Du LB, Yang L, Liu YQ, Zhang YZ, Zhang K, Qiao YL, He J, Dai M. Clinical characteristics and medical service utilization of lung cancer in China, 2005–2014: Overall design and results from a multicenter retrospective epidemiologic survey. Lung Cancer 2019; 128:91-100. [PMID: 30642458 DOI: 10.1016/j.lungcan.2018.11.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 01/05/2023]
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29
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Zhou Q, Fan Y, Wang Y, Qiao Y, Wang G, Huang Y, Wang X, Wu N, Zhang G, Zheng X, Bu H, Li Y, Wei S, Chen L, Hu C, Shi Y, Sun Y. [China National Lung Cancer Screening Guideline with Low-dose Computed
Tomography (2018 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018. [PMID: 29526173 PMCID: PMC5973012 DOI: 10.3779/j.issn.1009-3419.2018.02.01] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice. METHODS The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. RESULTS Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. CONCLUSIONS A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
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Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center/Lung Cancer Institute, West China University, Sichuan University, Chengdu 610041, China.,Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Yaguang Fan
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Ying Wang
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Youlin Qiao
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Guiqi Wang
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Yunchao Huang
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital of Yunnan Province, Kunming 650105, China
| | - Xinyun Wang
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Ning Wu
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | | | | | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yin Li
- Cancer Hospital of Henan Province, Zhengzhou 450008, China
| | - Sen Wei
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Liang'an Chen
- General Hospital of People's Liberation Army, Beijing 100853, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsa 410008, China
| | - Yuankai Shi
- Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Yan Sun
- Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
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Sihoe ADL, Cardillo G. Solitary pulmonary ground-glass opacity: is it time for new surgical guidelines? Eur J Cardiothorac Surg 2018; 52:848-851. [PMID: 28977403 DOI: 10.1093/ejcts/ezx211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022] Open
Abstract
As screening for lung cancer becomes more common around the world, so too does detection of pulmonary ground-glass opacities (GGOs). Although a number of guidelines have been published that cover the management of GGOs, they typically feature some common themes. These include basing management and surveillance on a limited number of computed tomography imaging criteria only, inadequate consideration of the pros and cons of non-surgical biopsy versus surgery, inadequate consideration of modern advances in surgery for GGOs and inadequate consideration of potential variations in pathology in different parts of the world. As GGOs become increasingly common in thoracic surgical practice, it may be appropriate to draft new guidelines for the clinical management GGOs that take a more distinctly surgical and international perspective.
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Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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31
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Li X, Zhou X, Fan Y, Zhang Y, Zu L, Yao F, Zhou Q. WW45, a Gli1 binding protein, negatively regulated Hedgehog signaling in lung cancer. Oncotarget 2018; 7:68966-68975. [PMID: 27661123 PMCID: PMC5356604 DOI: 10.18632/oncotarget.12155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023] Open
Abstract
Over-expression of Gli1 is very common in lung cancer. However, the underlying molecular mechanism remains largely unknown. Here, using mass spectrum, we have identified WW45 as a binding partner of Gli1. WW45 interacted with Gli1, promoted its ubiquitination and inhibited the expression of its target genes. In the functional studies, WW45 inhibited the growth and migration of lung cancer cells. Knocking down the expression of WW45 promoted the growth and migration of lung cancer cells, which was rescued by down-regulation of Gli1. Moreover, over-expression of WW45 inhibited the tumorigenesis in a de novo lung cancer tumorigenesis mouse model (LKB-Ras) as well as the expression of Gli1. Also over-expression of WW45 improved the survival of these mice. In addition, the expression of WW45 was down-regulated in the clinical lung cancer samples, which was inversely correlated with the expression of Gli1. Taken together, this study demonstrated the suppressive roles of WW45 in lung cancer by inhibiting the Hedgehog/Gli1 signaling.
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Affiliation(s)
- Xuebing Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xuexia Zhou
- Department of Neuropathology, Tianjin Key Laboratory of Injuries, Variations and Regeneration of the Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yaguang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yalong Zhang
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lingling Zu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qinghua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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32
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Low-dose CT for lung cancer screening: opportunities and challenges. Front Med 2017; 12:116-121. [PMID: 29218678 DOI: 10.1007/s11684-017-0600-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Abstract
Lung cancer is among the most frequently diagnosed cancers worldwide and the leading cause of cancer death in both males and females. Screening for lung cancer coupled with earlier intervention has long been studied as an approach to mortality reduction. However, minimal progress was achieved until recently, when lowdose spiral computed tomography (LDCT) screening demonstrated a 20% reduction in mortality from lung cancer in a randomized controlled trial (RCT), the National Lung Screening Trial, from the United States. On the basis of this finding, LDCT has been recommended for lung cancer screening in high-risk populations by several clinical guidelines. However, results from the following independent RCTs in Europe failed to show consistent conclusions. In addition, intractable problems gradually emerged with the progress of LDCTscreening. This paper summarizes and discusses the main observations and challenges of LDCT screening for lung cancer. Before spreading implementation of LDCTscreening, challenges, including high false-positive rates, overdiagnosis, enormous costs, and radiation risk, must be addressed. Complementary biomarkers and technical improvement are expected in the field of lung cancer screening in the near future.
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Duan X, Liu Z, Xu S. [Research Progresses of Circulating Tumor Cells in Diagnosis and Treatment of
Early Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:703-709. [PMID: 29061218 PMCID: PMC5972993 DOI: 10.3779/j.issn.1009-3419.2017.10.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
循环肿瘤细胞(circulating tumor cells, CTCs)作为液体活检的一种重要类型,在肺癌的筛查诊断、疗效评估、术后监测与预后判断等方面显示出越来越丰富的临床价值。随着对肺癌高危人群筛查工作的进展,大量肺小结节患者被检出,但是肺小结节不等于肺癌,而且据统计良性比例达90%-95%,这使得该部分患者在首次就诊时的良恶性鉴别诊断成为临床医生面临着的新的机遇与挑战。CTCs检测技术的不断进步与完善,是否可以在早期肺癌的鉴别诊断中发挥更大的作用,此外,它是否对早期肺癌手术治疗时的操作具有指导意义,这还需要进一步科研探索,以期将来实现临床转化。
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Affiliation(s)
- Xinchun Duan
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
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Wang Z, Han W, Zhang W, Xue F, Wang Y, Hu Y, Wang L, Zhou C, Huang Y, Zhao S, Song W, Sui X, Shi R, Jiang J. Mortality outcomes of low-dose computed tomography screening for lung cancer in urban China: a decision analysis and implications for practice. CHINESE JOURNAL OF CANCER 2017; 36:57. [PMID: 28709441 PMCID: PMC5512753 DOI: 10.1186/s40880-017-0221-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality outcomes in trials of low-dose computed tomography (CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect. METHODS A decision tree model with three scenarios (low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort (100,000 smokers aged 45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality (primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables. RESULTS Among the 100,000 subjects, there were 448, 541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively (17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7 and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, low-dose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths (relative numbers) with low-dose CT screening in the worst and optimal cases were 16 (5.4%) and 288 (40.2%) over no screening, respectively. CONCLUSIONS In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China. However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.
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Affiliation(s)
- Zixing Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Wei Han
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Weiwei Zhang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Fang Xue
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Yuyan Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Yaoda Hu
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Lei Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
| | - Chunwu Zhou
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021 P. R. China
| | - Yao Huang
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021 P. R. China
| | - Shijun Zhao
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021 P. R. China
| | - Wei Song
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 P. R. China
| | - Xin Sui
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 P. R. China
| | - Ruihong Shi
- National Institutes for Food and Drug Control, State Food and Drug Administration, Beijing, 100050 P. R. China
| | - Jingmei Jiang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 P. R. China
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36
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Sheehan DF, Criss SD, Gazelle GS, Pandharipande PV, Kong CY. Evaluating lung cancer screening in China: Implications for eligibility criteria design from a microsimulation modeling approach. PLoS One 2017; 12:e0173119. [PMID: 28273181 PMCID: PMC5342219 DOI: 10.1371/journal.pone.0173119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/15/2017] [Indexed: 11/18/2022] Open
Abstract
More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare & Medicaid Services (CMS). The China LCPM, built using an existing lung cancer microsimulation model, can project population outcomes associated with interventions for smoking-related diseases. After calibrating the model to published Chinese smoking prevalence and lung cancer mortality rates, we simulated screening from 2016 to 2050 based on eligibility criteria from the CMS and Chinese guidelines, which differ by age to begin and end screening, pack-years smoked, and years since quitting. Outcomes included number of screens, mortality reduction, and life-years saved for each strategy. We projected that in the absence of screening, 14.98 million lung cancer deaths would occur between 2016 and 2050. Screening with the CMS guideline would prevent 0.72 million deaths and 5.8 million life-years lost, resulting in 6.58% and 1.97% mortality reduction in males and females, respectively. Screening with the Chinese guideline would prevent 0.74 million deaths and 6.6 million life-years lost, resulting in 6.30% and 2.79% mortality reduction in males and females, respectively. Through 2050, 1.43 billion screens would be required using the Chinese screening strategy, compared to 988 million screens using the CMS guideline. In conclusion, CT-based lung cancer screening implemented in 2016 and based on the Chinese screening guideline would prevent about 20,000 (2.9%) more lung cancer deaths through 2050, but would require about 445 million (44.7%) more screens than the CMS guideline.
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Affiliation(s)
- Deirdre F. Sheehan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Steven D. Criss
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - G. Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pari V. Pandharipande
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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37
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Gou HF, Liu Y, Yang TX, Zhou C, Chen XZ. Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations. Oncotarget 2017; 8:1788-1795. [PMID: 27705946 PMCID: PMC5352097 DOI: 10.18632/oncotarget.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the proportion of stage I lung cancer and population mortality in China to those in U.S. and Europe where lung cancer screening by low-dose computed tomography (LDCT) has been already well practiced. METHODS The proportions of stage I lung cancer in LDCT screening population in U.S. and Europe were retrieved from NLST and NELSON trials. The general proportion of stage I lung cancer in China was retrieved from a rapid meta-analysis, based on a literature search in the China National Knowledge Infrastructure database. The lung cancer mortality and prevalence of China, U.S. and Europe was retrieved from Globocan 2012 fact sheet. Mortality-to-prevalence ratio (MPR) was applied to compare the population survival outcome of lung cancer. RESULTS The estimated proportion of stage I lung cancer in China is merely 20.8% among hospital-based cross-sectional population, with relative ratios (RRs) being 2.40 (95% CI 2.18-2.65) and 2.98 (95% CI 2.62-3.38) compared by LDCT-screening population in U.S. and Europe trials, respectively. MPR of lung cancer is as high as 58.9% in China, with RRs being 0.46 (95% CI 0.31-0.67) and 0.58 (95% CI 0.39-0.85) compared by U.S. and Europe, respectively. CONCLUSIONS By the epidemiological inference, the LDCT mass screening might be associated with increasing stage I lung cancer and therefore improving population survival outcome. How to translate the experiences of lung cancer screening by LDCT from developed counties to China in a cost-effective manner needs to be further investigated.
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Affiliation(s)
- Hong-Feng Gou
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Liu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Tian-Xia Yang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Zhou
- Translational Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion Therapy Center (HIT), Department of Radiation Oncology, University Heidelberg Medical School, Heidelberg, Germany
- German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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周 清, 范 亚, 王 颖, 乔 友, 王 贵, 黄 云, 王 新, 吴 宁, 张 国, 郑 向, 步 宏. [China National Guideline of Classification, Diagnosis and Treatment for Lung Nodules (2016 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:793-798. [PMID: 27978863 PMCID: PMC5973458 DOI: 10.3779/j.issn.1009-3419.2016.12.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- 清华 周
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China University, Sichuan University, Chengdu 610041, China
- 300052 天津,天津医科大学总医院,天津市肺癌研究所Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
| | - 亚光 范
- 300052 天津,天津医科大学总医院,天津市肺癌研究所Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
| | - 颖 王
- 300052 天津,天津医科大学总医院Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 友林 乔
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
- 100021 北京,国家癌症中心/中国医学科学院肿瘤医院National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 贵齐 王
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
- 100021 北京,国家癌症中心/中国医学科学院肿瘤医院National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 云超 黄
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
- 650105 昆明,昆明医科大学附属肿瘤医院Cancer Hospital, Kunming Medical University, Kunming 650105, China
| | - 新允 王
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
- 300052 天津,天津医科大学总医院Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 宁 吴
- 100021 北京,中国肺癌早诊早治专家组China National Expert Group of Early Diagnosis and Treatment of lung Cancer, Beijing 100021, China
- 100021 北京,国家癌症中心/中国医学科学院肿瘤医院National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 国桢 张
- 200040 上海,上海华东医院放射科Department of Radiology, Shanghai Huadong Hospital, Shanghai 200040, China
| | - 向鹏 郑
- 200040 上海,上海华东医院放射科Department of Radiology, Shanghai Huadong Hospital, Shanghai 200040, China
| | - 宏 步
- 610041 成都,四川大学华西医院病理科Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
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Pedersen JH, Ashraf H. Implementation and organization of lung cancer screening. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:152. [PMID: 27195270 DOI: 10.21037/atm.2016.03.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CT screening for lung cancer is now being implemented in the US and China on a widespread national scale but not in Europe so far. The review gives a status for the implementation process and the hurdles to overcome in the future. It also describes the guidelines and requirements for the structure and components of high quality CT screening programs. These are essential in order to achieve a successful program with the fewest possible harms and a possible mortality benefit like that documented in the American National Lung Screening Trial (NLST). In addition the importance of continued research in CT screening methods is described and discussed with focus on the great potential to further improve this method in the future for the benefit of patients and society.
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Affiliation(s)
- Jesper Holst Pedersen
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Haseem Ashraf
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
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Li S, Qin X, Li Y, Zhang X, Niu R, Zhang H, Cui A, An W, Wang X. MiR-133a suppresses the migration and invasion of esophageal cancer cells by targeting the EMT regulator SOX4. Am J Transl Res 2015; 7:1390-1403. [PMID: 26396670 PMCID: PMC4568795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/01/2015] [Indexed: 06/05/2023]
Abstract
MicroRNAs (miRNAs) are small, non-coding RNAs which can function as oncogenes or tumor suppressor genes in human cancers. In the present study, we demonstrated that the expression ofmiR-133a was dramatically decreased in examined esophageal squamous cell carcinoma (ESCC) cell lines and clinical ESCC tissue samples. Additionally, miR-133a expression was inversely correlated with tumor progression in ESCCs. We have found that over-expression of miR-133a significantly suppressed the proliferation, migration and invasion of ESCC cells in vitro. miR-133a over-expression also significantly suppressed the aggressive phenotype of ESCC in vivo, suggesting that miR-133a may function as a novel tumor suppressor. Further studies indicated that the EMT-related transcription factor Sox4 was a direct target gene of miR-133a, evidenced by the direct binding of miR-133a with the 3'UTR of Sox4. Notably, the EMT marker E-cadherin or vimentin, a downstream of Sox4, was also down-regulated or upregulated upon miR-133a treatment. We have also shown that over-expressing or silencing Sox4 was able to elevate or inhibit the migration and invasion of ESCC cells, similar to the effect of miR-133a on the ESCC cells. Moreover, knockdown of Sox4 reversed the enhanced migration and invasion mediated by anti-miR-133a. These results demonstrate that miR-133a acts as a tumor suppressor in ESCC through targeting Sox4 and the EMT process. miR-133a may serve as a potential target in the treatment of human esophageal cancer.
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Affiliation(s)
- Shujun Li
- Department of Thoracic Surgery, Second Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Xuebo Qin
- Department of Thoracic Surgery, Hebei Chest HospitalShijiazhuang, China
| | - Yang Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenviroment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital TianjinChina
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest HospitalShijiazhuang, China
| | - Ren Niu
- Department of Cancer Center, Second Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Helin Zhang
- Department of Thoracic Surgery, Second Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Airong Cui
- Department of Pathology, Second Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Wenting An
- Central Laboratory, Second Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Xiaolu Wang
- Department of Cancer Center, Second Hospital of Hebei Medical UniversityShijiazhuang, China
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Zhou QH, Fan YG, Bu H, Wang Y, Wu N, Huang YC, Wang G, Wang XY, Qiao YL. China national lung cancer screening guideline with low-dose computed tomography (2015 version). Thorac Cancer 2015; 6:812-8. [PMID: 26557925 PMCID: PMC4632939 DOI: 10.1111/1759-7714.12287] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/19/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in China. Results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. METHODS A China national lung cancer screening guideline was developed by lung cancer early detection and treatment expert group appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. RESULTS Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. CONCLUSIONS A lung cancer screening guideline is provided for the high-risk population in China.
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Affiliation(s)
- Qing-Hua Zhou
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University Chengdu, China ; Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Ya-Guang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Hong Bu
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University Chengdu, China ; Department of Pathology, West China Hospital, Sichuan University Chengdu, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital Tianjin, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, China
| | - Yun-Chao Huang
- Department of Thoracic Cardiovascular Surgery, the Third Affiliated Hospital of Kunming Medical College (Yunnan Tumor Hospital) Kunming, China
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, China
| | - Xin-Yun Wang
- Department of Pathology, Tianjin Medical University General Hospital Tianjin, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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Yu S, Yang CS, Li J, You W, Chen J, Cao Y, Dong Z, Qiao Y. Cancer Prevention Research in China. Cancer Prev Res (Phila) 2015; 8:662-74. [PMID: 26076697 DOI: 10.1158/1940-6207.capr-14-0469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/21/2015] [Indexed: 11/16/2022]
Abstract
Although cancer incidence and mortality rates in the United States and some European countries have started to decrease, those in developing countries are increasing. China, the most populous developing country, is facing a serious challenge from cancer. Cancer incidence has been increasing for decades, and cancer is the leading cause of death in China. In 2012, the cancer incidence was 174.0 per 100,000, and the cancer mortality was 122.2 per 100,000 in China. In addition to the still-prevalent traditional Chinese cancers of the stomach, liver, esophagus, cervix, and nasopharynx, the incidence of "Western" cancers such those of the lung, breast, and colorectum has increased alarmingly in recent years. These increases are likely due to the lifestyle and environmental changes associated with rapid economic development and population aging. More importantly, a large portion of these cancers are preventable. Researchers in China have made important contributions to cancer prevention research, especially in the traditional Chinese cancers. More cancer prevention research and measures, especially on the major emerging cancers, are urgently needed. This review article highlights some of the past achievements and present needs in cancer prevention research in China and suggests important areas for future studies.
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Affiliation(s)
- Siwang Yu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China.
| | - Chung S Yang
- Department of Chemical Biology and Center for Cancer Prevention Research, Rutgers University, Piscataway, New Jersey.
| | - Junyao Li
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weicheng You
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianguo Chen
- Qidong Liver Cancer Institute, Nantong University Liver Cancer Institute, Jiangsu, China
| | - Ya Cao
- Cancer Research Institute, Central South University, Changsha, China
| | - Zigang Dong
- Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Youlin Qiao
- National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhao SJ, Wu N. Early detection of lung cancer: Low-dose computed tomography screening in China. Thorac Cancer 2015; 6:385-9. [PMID: 26273391 PMCID: PMC4511314 DOI: 10.1111/1759-7714.12253] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/16/2015] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is currently the leading cause of cancer-related death in China and western countries for both men and women. Overall, the five-year survival rate of lung cancer is approximately 15%, whereas the five-year survival for patients with surgically resected early-stage disease is 60–80%. Screening is conceptually a good strategy for reducing the mortality rate of lung cancer. Randomized controlled trials in the 1960s and 1970s found that chest radiographic screening did not result in a reduction in mortality for high-risk individuals. Recently published data from the National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality in subjects who underwent low-dose computed tomography (LDCT) screening compared to those randomized to conventional chest X-ray. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. More results from European randomized controlled trials are expected in the next few years. Recently, a number of lung cancer screening studies using LDCT have been initiated in China. This article briefly summarizes the results of the current and previous lung cancer screening trials worldwide, and focuses on the current status of LDCT lung cancer screening in China.
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Affiliation(s)
- Shi-Jun Zhao
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, China
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Li XB, Gu JD, Zhou QH. Review of aerobic glycolysis and its key enzymes - new targets for lung cancer therapy. Thorac Cancer 2015; 6:17-24. [PMID: 26273330 PMCID: PMC4448463 DOI: 10.1111/1759-7714.12148] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/10/2014] [Indexed: 02/05/2023] Open
Abstract
Most tumor cells show different metabolic pathways than normal cells. Even under the conditions of sufficient oxygen, they produce energy by a high rate of glycolysis followed by lactic acid fermentation in the cytosol, which is known as aerobic glycolysis or the Warburg effect. Lung cancer is a malignant tumor with one of the highest incidence and mortality rates in the world at present. However, the exact mechanisms underlying lung cancer development remain unclear. The three key enzymes of glycolysis are hexokinase, phosphofructokinase, and pyruvate kinase. Lactate dehydrogenase catalyzes the transfer of pyruvate to lactate. All four enzymes have been reported to be overexpressed in tumors, including lung cancer, and can be regulated by many oncoproteins to promote tumor proliferation, migration, and metastasis with dependence or independence of glycolysis. The discovery of aerobic glycolysis in the 1920s has provided new means and potential therapeutic targets for lung cancer.
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Affiliation(s)
- Xue-Bing Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Jun-Dong Gu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Qing-Hua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Environment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China ; Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Sichuan University Chengdu, China
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Wang X, Wang Y, Li S, Dong B, Zheng Q, Yan S, Ma Y, Zhang J, Fang J, Wu N, Wu H, Yang Y. Decreased maspin combined with elevated vascular endothelial growth factor C is associated with poor prognosis in non-small cell lung cancer. Thorac Cancer 2014; 5:383-90. [PMID: 26767029 DOI: 10.1111/1759-7714.12104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/24/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate the clinical significance of the combination of maspin and vascular endothelial growth factor (VEGF)-C expression in the prognosis of non-small cell lung cancer (NSCLC). METHODS Immunohistochemistry was performed to assay the expression of maspin and VEGF-C in primary tumor tissues, metastatic, and non-metastatic lymph nodes in 98 NSCLC patients. Survival analysis was determined by Kaplan-Meier curves. RESULTS The positive expression rate of maspin was 26.5% (26/98) in NSCLC primary tumor tissues, significantly associated with histological type (P = 0.005) and the absence of nodal metastasis (P < 0.001). The expression of maspin in primary tumor tissues was stronger than metastatic lymph nodes of the N1 group (P = 0.048), while the metastatic lymph nodes of the N1 group had a stronger maspin expression than the N2 group (P = 0.008). In survival analysis, a positive expression of maspin of the N1 lymph node was also found to be an independent positive prognostic factor in overall survival (P = 0.003). We also found that decreased maspin combined with elevated VEGF-C is associated with a poor prognosis for disease-free survival (P = 0.019). CONCLUSION Our results suggest that positive expression of maspin might significantly inhibit nodal metastasis in NSCLC. Decreased maspin combined with elevated VEGF-C might be associated with a poor prognosis in NSCLC.
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Affiliation(s)
- Xing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Yang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Respiratory Medicine, Peking University Cancer Hospital & Institute Beijing, China
| | - Shaolei Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Bin Dong
- Department of Pathology, Peking University Cancer Hospital & Institute Beijing, China
| | - Qingfeng Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Yuanyuan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Jianzhi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Jian Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Respiratory Medicine, Peking University Cancer Hospital & Institute Beijing, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
| | - Huijuan Wu
- Beijing Center for Physical and Chemical Analysis Beijing, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery, Peking University Cancer Hospital & Institute Beijing, China
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任 冠, 叶 剑, 范 亚, 王 竞, 孙 志, 贾 辉, 杜 欣, 候 朝, 王 颖, 赵 永, 周 清. [Survey and analysis of awareness of lung cancer prevention and control in a LDCT lung cancer screening project in Tianjin Dagang Oilfield of China]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:163-70. [PMID: 24581169 PMCID: PMC6000055 DOI: 10.3779/j.issn.1009-3419.2014.02.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE It has been proven that increase of the awareness level of lung cancer prevention and control could enhance participation of lung cancer screening of lung cancer high risk group. The aim of this study is to investigate the awareness level of lung cancer prevention and control and the effect of individual characteristics on lung cancer awareness, and to provide evidence for comprehensive lung cancer prevention in high risk areas of lung cancer. METHODS Staffs of Tianjin Dagang Oil Field who participate low dose CT (LDCT) lung cancer screening by cluster sampling or according to voluntary principle were surveyed, data of lung cancer awareness were collected by questionnaire. RESULTS A total of 1,633 valid questionnaires were collected. The average age of respondents was 60.08±6.58. Most participants were males (82.2%) while female only accounted for 17.8%. The proportions of awareness about lung cancer in China, risk factors, screening methods and the knowledge of health examination were 64.5%, 77.1%, 43.7%, 49.6% respectively. Result of multiple logistic regression analysis showed that education level, smoking (pack-year), age, prior tuberculosis were the influencing factors of lung cancer awareness with adjusted Ors for education and age level as of 0.567 (95%CI: 0.439-0.733) and 1.373 (95%CI: 1.084-1.739) respectively. 80.3% of the participants can accept health examination once a year, while the ability to pay the medical expenses was not high. The influencing factors of health examination willingness were gender, age, income, the knowledge of lung cancer. CONCLUSIONS Education level and smoking affect the awareness of lung cancer prevention and control, health education for lung cancer should be conducted especially in population with low education level. Comprehensive lung cancer control in high risk areas should combined lung cancer screening, tobacco control and health education.
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Affiliation(s)
- 冠华 任
- 300192 天津,天津市核医学重点实验室,中国医学科学院放射医学研究所,北京协和医学院Peking Union Medical College & Institute of radiation medicine, Chinese Academy of Medical Science, Tianjin 300192, China
| | - 剑飞 叶
- 300280 天津,大港油田总医院Department of Thoracic Surgery, Dagang Oil Field General Hospital, Tianjin 300280, China
| | - 亚光 范
- 300052 天津,天津市肺癌转移与肿瘤微环境重点实验室,天津肺癌研究所,天津医科大学总医院Tianjin Key Laboratory of Lung cancer Metastasis and Tumor Microenvironment, Tianjin Lung cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 竞 王
- 300052 天津,天津市肺癌转移与肿瘤微环境重点实验室,天津肺癌研究所,天津医科大学总医院Tianjin Key Laboratory of Lung cancer Metastasis and Tumor Microenvironment, Tianjin Lung cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 志娟 孙
- 300280 天津,大港油田总医院Department of Thoracic Surgery, Dagang Oil Field General Hospital, Tianjin 300280, China
| | - 辉 贾
- 300280 天津,大港油田总医院Department of Thoracic Surgery, Dagang Oil Field General Hospital, Tianjin 300280, China
| | - 欣欣 杜
- 300052 天津,天津市肺癌转移与肿瘤微环境重点实验室,天津肺癌研究所,天津医科大学总医院Tianjin Key Laboratory of Lung cancer Metastasis and Tumor Microenvironment, Tianjin Lung cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 朝华 候
- 300280 天津,大港油田总医院Department of Thoracic Surgery, Dagang Oil Field General Hospital, Tianjin 300280, China
| | - 颖 王
- 天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 永成 赵
- 300192 天津,天津市核医学重点实验室,中国医学科学院放射医学研究所,北京协和医学院Peking Union Medical College & Institute of radiation medicine, Chinese Academy of Medical Science, Tianjin 300192, China
| | - 清华 周
- 300052 天津,天津市肺癌转移与肿瘤微环境重点实验室,天津肺癌研究所,天津医科大学总医院Tianjin Key Laboratory of Lung cancer Metastasis and Tumor Microenvironment, Tianjin Lung cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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