本文關(guān)鍵詞： 肺癌 篩查 低劑量 X線計(jì)算機(jī) 女性 肺結(jié)節(jié) 篩查 低劑量 年齡 吸煙指數(shù)　出處：《北京協(xié)和醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的報(bào)道中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院4690例無(wú)癥狀受檢者肺癌LDCT篩查結(jié)果。方法簽署知情同意書后,4690名年齡在40歲及以上的無(wú)癥狀體檢者接受LDCT檢查。根據(jù)NCCN標(biāo)準(zhǔn)(version 2.2014)將篩查人群分為高、中、低危三組,并根據(jù)性別、吸煙史及二手煙接觸史分為女性和男性非吸煙者二手煙暴露組。掃描方案、診斷及隨訪標(biāo)準(zhǔn)參照I-ELCAP。所有實(shí)性/部分實(shí)性結(jié)節(jié)≥5mm或非實(shí)性結(jié)節(jié)≥8mm判斷為陽(yáng)性結(jié)節(jié),提出隨診方案或進(jìn)一步醫(yī)學(xué)檢查,并按計(jì)劃隨訪觀察結(jié)節(jié)大小變化。TNM分期以臨床證據(jù)及病理診斷為標(biāo)準(zhǔn)。結(jié)果三組LDCT檢查陽(yáng)性率分別為27.0%(86/319),19.3%(199/1029)和11.3%(377/3342)。26名受檢者中檢出肺癌27灶,通過(guò)手術(shù)病理證實(shí)23例(24灶)非小細(xì)胞肺癌中早期肺癌19灶,早診率76.0%。高、中、低危三組肺癌檢出率無(wú)統(tǒng)計(jì)學(xué)差異(P=0.054)。腫瘤大小6.9-29.5mm(中位值16.3mm)。對(duì)于40歲或以上非吸煙有二手煙接觸史女性,惡性結(jié)節(jié)檢出率在陽(yáng)性結(jié)節(jié)病例中的比例與高危組比較差異有統(tǒng)計(jì)學(xué)意義(7.19% vs.2.94%,P=0.002)。結(jié)論LDCT適用于對(duì)無(wú)癥狀健康人群進(jìn)行肺癌篩查,肺癌檢出率為0.6%,早期肺癌檢出率高,達(dá)76.0%。應(yīng)充分重視對(duì)中國(guó)40歲以上有二手煙接觸史的女性非吸煙者的早期肺癌篩查的相關(guān)研究。目的：評(píng)估早期肺癌篩查L(zhǎng)DCT肺結(jié)節(jié)的檢出與受檢者年齡、吸煙狀態(tài)與吸煙量的關(guān)系。材料及方法：2008年7月-2012年6月間在中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院影像診斷科行早期肺癌篩查基線LDCT檢查,年齡≥40歲并詳細(xì)填寫年齡、吸煙狀態(tài)及每日吸煙量及吸煙年數(shù)的受檢者,共3363例納入本研究。根據(jù)年齡分為5組：40-49歲、50-59歲、60-69歲、70-79歲和80-89歲共5組；根據(jù)吸煙狀態(tài)及吸煙量分為4組：非吸煙者、輕度吸煙者(吸煙指數(shù)SI20)、重度吸煙者(20≤SI30)和極重度吸煙者(SI≥30)。LDCT結(jié)果依據(jù)I-ELCAP結(jié)節(jié)隨訪流程進(jìn)行。分析不同年齡組、不同吸煙狀態(tài)組的肺內(nèi)結(jié)節(jié)檢出情況、肺內(nèi)陽(yáng)性結(jié)節(jié)檢出情況,并分析年齡與吸煙狀態(tài)與肺結(jié)節(jié)檢出的相關(guān)性。結(jié)果：2295例受檢者(68.2%)基線LDCT至少檢出一枚肺內(nèi)非鈣化結(jié)節(jié)。不同年齡組中肺內(nèi)結(jié)節(jié)檢出率為64.1%(40-49歲)、71.4%(50-59歲)、74.7%(60-69歲)、76.0%(70-79歲)、66.7%(80-89歲),其中50-79歲三組檢出率明顯高于40-49歲組和80-89歲組,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。不同吸煙狀態(tài)組肺內(nèi)結(jié)節(jié)檢出率分別為67.7%(非吸煙組)、68.7%(輕度吸煙組)、65.8%(重度吸煙組)、71.4%(極重度吸煙組),極重度吸煙組肺內(nèi)結(jié)節(jié)檢出率最高,但各組差異無(wú)統(tǒng)計(jì)學(xué)意義(P=-0.269)。肺內(nèi)非鈣化結(jié)節(jié)檢出數(shù)量、結(jié)節(jié)大小與受檢者年齡、吸煙指數(shù)呈正相關(guān)(0.110/0.111、0.115/0.048)。556例受檢者至少檢出1枚陽(yáng)性結(jié)節(jié)。不同年齡組中陽(yáng)性結(jié)節(jié)檢出率為11.9%、17.9%、25.1%、37.6%、25.0%。40-79歲組中,陽(yáng)性結(jié)節(jié)檢出率明顯上升,組間差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。不同吸煙狀態(tài)組陽(yáng)性結(jié)節(jié)檢出率為16.1%、14.3%、13.7%、22.8%,極重度吸煙組陽(yáng)性結(jié)節(jié)檢出率最高,較其它3組差異有統(tǒng)計(jì)學(xué)意義(P0.001)。25例受檢者中檢出惡性結(jié)節(jié)(0.7%),惡性結(jié)節(jié)在不同年齡組中的檢出率分別為：0.5%、0.7%、0.9%、4.0%,其中70-79歲組較其它3個(gè)年齡組明顯增高,且差異有統(tǒng)計(jì)學(xué)意義(P0.001)。惡性結(jié)節(jié)在不同吸煙狀態(tài)組中的檢出率分別為1.0%、0.1%、0.7%和0.7%,非吸煙組較吸煙組高(1.0% vs.0.5%),各吸煙組間差異無(wú)統(tǒng)計(jì)學(xué)意義。70-79歲組檢出肺內(nèi)結(jié)節(jié)大小(4.5±3.6mm)、肺內(nèi)陽(yáng)性結(jié)節(jié)大小(9.7±5.7mm)及惡性結(jié)節(jié)大小(18.3±6.8mm)均較其它3組為大,且差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論：LDCT肺內(nèi)結(jié)節(jié)及陽(yáng)性結(jié)節(jié)檢出率隨受檢者年齡的增長(zhǎng)、吸煙指數(shù)增高而增長(zhǎng)。LDCT肺內(nèi)結(jié)節(jié)及陽(yáng)性結(jié)節(jié)的檢出數(shù)量及結(jié)節(jié)大小與年齡及吸煙指數(shù)呈正相關(guān)。肺內(nèi)惡性結(jié)節(jié)檢出率與受檢者年齡呈正相關(guān),與吸煙指數(shù)關(guān)系不大。
[Abstract]:Objective to report the tumor hospital of Chinese Academy of Medical Sciences in 4690 asymptomatic subjects with lung cancer screening results. Methods LDCT signed informed consent, at the age of 4690 asymptomatic subjects aged 40 years and above the accepted LDCT examination. According to the NCCN standard (version 2.2014) will be screened were divided into high, low risk group three. According to gender, smoking and secondhand smoke exposure is divided into male and female non smokers exposed to secondhand smoke. Scanning scheme, the diagnosis and follow-up of I-ELCAP. reference standard of all solid / solid nodules larger than 5mm or non solid nodules larger than 8mm was judged as positive node, put forward the follow-up plan or further medical examination. According to the plan and follow-up observation of nodule size changes of.TNM staging with clinical evidence and pathological diagnosis standard. Results the positive rate of the three groups of LDCT examination were 27% (86/319), 19.3% (199/1029) and 11.3% (377/3342).26 subjects were detected in 27 lung cancer Through the lesions, 23 cases were confirmed by surgical pathology (24 lesions) of non-small cell lung cancer in early stage lung cancer 19 foci, early diagnosis rate of 76.0%. is high, low risk group, three lung cancer detection rate showed no significant difference (P=0.054). The tumor size 6.9-29.5mm (median 16.3mm). For 40 years or more non smoking second-hand smoke contact history of female malignant nodules detection rate in the case of positive nodules and the proportion of high-risk group had significant difference (7.19% vs.2.94%, P=0.002). Conclusion LDCT is suitable for screening for lung cancer in asymptomatic healthy population, lung cancer detection rate was 0.6%. The detection rate of early lung cancer, 76.0%. should pay full attention to the related research on Chinese over the age of 40 years of second-hand smoke exposure history of female non smokers early lung cancer screening. Objective: To evaluate the early lung cancer screening LDCT Pulmonary Nodules Detection and patient age, the relationship between smoking status and smoking. Materials and methods: -201 July 2008 2 year in June in the cancer hospital Chinese Academy of Medical Sciences for early lung cancer screening LDCT baseline examination, 40 years of age or older and fill in the age of subjects and the amount of smoking status and daily smoking, the number of years, a total of 3363 cases were included in this study. According to the age were divided into 5 groups: 40-49, 50-59 the age, 60-69 years, 70-79 years and 80-89 years old were divided into 5 groups according to smoking status and smoking; divided into 4 groups: non smokers, mild smokers (smoking index SI20), heavy smokers (20 SI30) and heavy smokers (SI = 30).LDCT I-ELCAP according to the results of follow-up process. Analysis of nodules of different ages group, pulmonary nodule detection in different smoking status group, lung nodules were positive, and positive correlation analysis between age and smoking status and pulmonary nodules. Results: 2295 subjects (68.2%) at least a baseline LDCT detection of pulmonary non calcified nodules. In the age group of pulmonary nodules detection rate was 64.1% (40-49 years), 71.4% (50-59 years), 74.7% (60-69 years), 76% (70-79 years), 66.7% (80-89 years), of which 50-79 years the detection rate of the three groups were significantly higher than that of 40-49 years and 80-89 years age group, the difference was statistically significant (P0.001). With the smoking status group pulmonary nodules detection rate was 67.7% (non smoking group), 68.7% (mild smoking group), 65.8% (severe smoking group), 71.4% (severe smoking group, smoking group) with severe pulmonary nodules detection rate is the highest, but no significant difference between groups (P=, -0.269). The lungs of non calcified nodules the number of detected nodules, and patient age, smoking index was positively correlated with.556 (0.110/0.111,0.115/0.048) subjects at least 1 positive nodes. The detection of different age groups in the positive nodules detection rate was 11.9%, 17.9%, 25.1%, 37.6%, 25 in the%.40-79 group, the positive nodules detection rate increased significantly, the differences were between groups Statistical significance (P0.001). Different smoking status group positive nodules detection rate was 16.1%, 14.3%, 13.7%, 22.8%, severe smoking group positive nodules detection rate was statistically significant compared with the other 3 groups (P0.001) of malignant nodules.25 subjects (0.7%), the rate for malignant nodules in different age groups: 0.5%, 0.7%, 0.9%, 4%, 70-79 years old group than the other 3 age groups were significantly increased, and the difference was statistically significant (P0.001). The detection rate was 1%, malignant nodules in different smoking status in the group of 0.1%, 0.7% and 0.7%, non smoking group and smoking group high (1% vs.0.5%), the difference between the smoking group was not statistically significant.70-79 age group detected pulmonary nodule size (4.5 + 3.6mm), positive pulmonary nodules (9.7 + 5.7mm) and malignant nodules (18.3 + 6.8mm) were lower than the other 3 groups, and the difference was statistically significant (P0.001). Conclusion: LDCT lung In the positive detection rate of nodules and nodules with subject age, smoking index increased and the number of nodule size was positively detected with age and smoking index and growth of.LDCT pulmonary nodules and positive nodules. The detection rate of malignant lung nodules and the subjects age was positively correlated with smoking index has little relationship.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R734.2;R730.44

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