近年来随着环境与空气质量的不断下降,肺癌死亡居高不下,已跃居全球范围内癌症死因的首位,而在我国近两年肺癌已成为恶性肿瘤死亡之首,且绝大部分肺癌发现时已到中晚期,其5年生存率在15%左右。尽管肺癌的5年生存率极低,但是由于早期肺癌筛查在美国的开展,早期肺癌5年生存率已达到90%以上,因此早诊断、早治疗是提高肺癌患者生存率的关键。低剂量螺旋CT应用于肺癌的早期筛查,其随机对照试验研究结果显示可降低20%肺癌死亡率,本文中作者主要就低剂量螺旋CT肺癌筛查的现状、问题及最新研究进展进行综述。

[1] JEMAL A,BRAY F,CENTER M M,et al.Global cancer statistics[J].CA Cancer J Clin,2011,61:69-90.
[2] National Cancer Institute.General information about non-small cell lung cancer[EB/OL].Available at:http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/health professional.Accessed December 24,2012.
[3] CHEN W Q,ZHANG S W,ZOU X N,et al.Lung cancer incidence and mortality in China,2009[J].Thoracic Cancer,2013,4(2):102-108.
[4] SIEGEL R,NAISHADHAM D,JEMAL A.Cancer statistics,2013[J].CA:Cance J Clin,2013,63(1):11-30.
[5] SMITH R A,GLYNN T J.Epidemiology of lung cancer[J].Radiol Clin North Am,2000,38(3):453-470.
[6] NAWA T,NAKAGAWA T,MIZOUE T,et al.Long-term prognosis of patients with lung cancer detected on low-dose chest computed tomography screening[J].Lung Cancer,2012,75(2):197-202.
[7] WANG J B,FAN Y G,JIANG Y,et al.Attributable causes of lung cancer incidence and mortality in China[J].Thoracic Cancer,2011,2(4):156-163.
[8] STRUSS G M,GLEASON R E,SUGARBAKER D J.Screening for lung cancer reexamined.A reinterpretation of the Mayo Lung Project randomized trial on lung cancer screening[J].Chest,1993,103(4):337-341.
[9] MARCUS P M,BERGSTRALH E J,FAGERSTROM R M,et al.Lung cancer mortality in the Mayo Lung Project:impact of extended follow-up[J].J Natl Cancer Inst,2000,92(16):1308-1316.
[10] 刘武杰,马晓伟.低剂量螺旋CT对肺癌高危人群筛查的价值[J].中国现代医生,2009,47(31):85-105.
[11] 任冠华,范亚光,赵永成,等.低剂量螺旋CT肺癌筛查研究进展[J].中国肺癌杂志,2013,16(10):553-558.
[12] NAIDICH D P,MARSHALL C H,GRIBBIN C,et al.Low-dose CT of the lungs:preliminary observations[J].Radiology,1990,175(3):729-731.
[13] BLANCHON T,BRECHOT J M,GRENIER P A,et al.Baseline results of the Depiscan study:a French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR)[J].Lung Cancer,2007,58(1):50-58.
[14] New York Early Lung Cancer Action Project Investigators.CT Screening for lung cancer:diagnoses resulting from the New York Early Lung Cancer Action Project[J].Radiology,2007,243(1):239-249.
[15] SHMUELI A,FRAIFELD S,RERETZ T,et al.Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer:the israeli experience[J].Value in Health,2013,16(6):922-931.
[16] PRIOLA A M,PRIOLA S M.Clinical implications and added costs of incidental findings in an early detection study of lung cancer by using low-dose spiral computed tomography[J].Clinical Lung Cancer March,2013,14(2):139-148.
[17] PEGNA A L,PICOZZI G.Design,recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT[J].Lung Cancer,2009,64:34-40.
[18] National Lung Screening Trial Research Team,ABERLE D R,ADMAS A M,et al.Reduced lung-cancer mortality with low-dose computed tomographic screening[J].N Engl J Med,2011,365(5):395-409.
[19] WENDER R,FONTHAM E T,BARRERA J R E,et al.American Cancer Society lung cancer screening guidelines[J].CA:Cancer J Clin,2013,63(2):107-117.
[20] HUMPHREY L L,DEFFEBACH M,PAPPAS M,et al.Screening for lung cancer with low-dose computed tomography:a systematic review to update the u.s.preventive services task force recommendation[J].Ann Intern Med,2013,159(6):411-420.
[21] SAGHIR Z,DIRKSE A,ASHRAF H,et al.CT screening for lung cancer brings forward early disease.The randomised Danish Lung Cancer Screening Trial:status after five annual screening rounds with low-dose CT[J].Thorax,2012,67(4):296-301.
[22] JEFFERS C D,PANDEY T,JAMBHEKAR K,et al.Effective use of low-dose computed tomography lung cancer screening[J].Curr Probl Diagn Radiol,2013,42(5):220-230.
[23] NAIR A,HANSELL D M.European and North American lung cancer screeningexperience and implications for pulmonary nodule management[J].Eur Radiol,2011,21(12):2445-2454.
[24] Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology(NCCN Guidelines®) for Lung Cancer ScreeningVersion1.2014.ⓒNational Comprehensive Cancer Network,Inc2013.All rights reserved.Accessed June 18,2013.To view the most recent and complete version of the guideline,goon line to www.nccn.org.NATIONAL COMPREHENSIVE CANCERNETWORK®,NCCN®,NCCN GUIDELINES®,and all other NCCN Contentare trademarks owned by the National Comprehensive Cancer Network,Inc.
[25] GOPAL M,ABDULLAH S E,GRADY J J,et al.Screening for lung cancer with low-dose computed tomography:a systematic review and meta-analysis of the baseline findings of randomized controlled trials[J].J Thorac Oncol,2010,5(8):1233-1239.
[26] BACH P B,MIRKIN J N,OLIVER T K,et al.Benefits and harms of CT screening for lung cancer:a systematic review[J].JAMA,2012,307(22):2418-2429.
[27] TOYODA Y,NAKAYAMA T,KUSUNOKI Y,et al.Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography[J].Br J Cancer,2008,98(10):1602-1607.
[28] JETT J.Screening for lung cancer:Who should be screened?[J].Arch Pathol Lab Med,2012,136(12):1511-1514.
[29] Wan Den BERGH K A,ESSINK-BOT M L,BORSBOOM G J,et al.Long-term effects of lung cancer computed tomography screening on health-related quality of life:the NELSON trial[J].Eur Respir J,2011,38(1):154-161.
[30] COX L S,CLARK M M,JETT J R,et al.Change in smoking status after spiral chest computed tomography scan screening[J].Cancer,2003,98(11):2495-2501.
[31] STYN M A,LAND S R,PERKINS K A,et al.Smoking behavior 1 year after computed tomography screening for lung cancer:effect of physician referral for abnormal CT findings[J].Cancer Epidemiol Biomarkers Prev,2009,18(12):3484-3489.
[32] Van Der AALST C M,Van KLAVEREN R J,Van Den BERGH K A,et al.The impact of a lung cancer computed tomography screening result on smoking abstinence[J].Eur Respir J,2011,37(6):1466-1473.
[33] 梁秀梅,谭勇.多层螺旋CT胸部体检低剂量研究[J].现代医学,2012,40(2):192-196.
[34] MA J,WARD E M,SMITH R,et al.Annual number of lung cancer deaths potentially avertable by screening in the United States[J].Cancer,2013,119(7):1381-1385.
[35] AOKI T M D,HANAMIYA M,URAMOTO H,et al.Adenocarcinoas with predominant ground-glass opacity:correlation of morphology and molecular biomarkers[J].Radiology,2012,264(2):590-596.
[36] YAMAMOTO S,KORN R L,OKLU R,et al.Thoracic imaging:CT radiogenomic characterization of ALK phenotype in non-small cell lung cancer[J].Radiology,2014,272(2):568-576.