| 楚 楚,韩颖颖,韩建周,等.2014—2023年江苏省南通市城市地区肺癌筛查和随访结果分析[J].中国肿瘤,2026,35(9):686-694. |
| 2014—2023年江苏省南通市城市地区肺癌筛查和随访结果分析 |
| Analysis of Lung Cancer Screening and Follow-Up Results in Urban Areas of Nantong City， Jiangsu Province from 2014 to 2023 |
| 投稿时间：2026-04-14 |
| DOI：10.11735/j.issn.1004-0242.2026.09.A005 |
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| 中文关键词: 肺癌 城市 早诊早治 筛查 随访 观察生存率 危险因素 江苏 |
| 英文关键词:lung cancer urban early diagnosis and treatment screening follow up observed survival rate risk factor Jiangsu |
| 基金项目: |
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| 摘要点击次数: 26 |
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| 中文摘要: |
| 摘 要：［目的］ 分析 2014—2023 年南通市国家重大公共卫生专项城市癌症早诊早治项目肺癌筛查人群随访结局，识别肺癌发病、死亡及生存相关危险因素。［方法］ 依据《城市癌症早诊早治项目技术方案》统一技术规范，收集 2014—2023 年南通市项目人群肺癌风险评估、临床筛查及基线人口学信息，联动南通市恶性肿瘤登记系统、全人群生命统计数据库开展被动随访，随访终点设定为 2025 年 12 月 31 日，提取研究对象自入组至随访截止日的肺癌发病、死亡结局。计算人群肺癌高危率、临床筛查参与率、肺癌阳性发病率、肺癌死亡率及观察生存率（observed survival rate，OSR）；单因素分析采用χ2检验，多因素分析采用Logistic回归模型。生存结局采用Kaplan-Meier法计算 OSR，Log-rank 检验完成生存单因素分析，Cox 比例风险回归模型开展生存多因素分析；将单因素分析有意义（P<0.05）的变量纳入多因素分析。［结果］ 本研究共纳入184 852 名风险评估对象，男性74 914 人（40.53%），女性109 938 人（59.47%）；筛查人群肺癌高危者 31 655 人，高危率为17.12%；高危人群中完成低剂量螺旋计算机断层扫描（low-dose computed tomography，LDCT）临床筛查 15 690 人，筛查参与率为49.57%。随访周期内累计确诊肺癌阳性病例 3 250 例，肺癌阳性发病率为1.76%；肺癌死亡 979 例，肺癌死亡率 为0.53%；肺癌确诊患者 1、3、5 年 OSR分别为 80.26%、73.75%、69.62%。本研究采用的肺癌风险评估模型灵敏度为31.51%，特异度为83.13%。肺癌发病独立危险因素为男性、高龄、吸烟史、慢性呼吸系统疾病史（P均＜0.05）；肺癌死亡独立危险因素为男性、高龄、未婚、低文化程度、吸烟史（P均＜0.001）；肺癌生存预后不良独立危险因素为男性、高龄、未婚、低文化程度、吸烟史（P均＜0.05）。［结论］ 南通市城市肺癌筛查人群整体高危率偏低，但筛查队列肺癌发病、死亡负担较重；经规范化早诊早治干预后肺癌患者长期生存水平显著提升。男性、高龄、存在吸烟及慢性呼吸系统疾病史人群为肺癌综合防控核心目标人群。应持续开展人群防癌健康宣教，提升居民健康素养与肺癌早筛主动就诊意识，减轻肺癌疾病造成的居民健康损害与社会经济负担。 |
| 英文摘要: |
| Abstract： ［Purpose］ To analyze lung cancer screening and long-term follow-up outcomes of participants enrolled in the National Urban Early Detection and Treatment Program for Cancer in Nantong City during 2014 to 2023， and to identify risk factors associated with lung cancer incidence， mortality and patient survival. ［Methods］ Based on the standardized technical protocol of the National Urban Early Detection and Treatment Program for Cancer， baseline data including lung cancer risk assessment results， clinical screening records and demographic characteristics were collected from 2014 to 2023. Passive follow-up was implemented by linking the study cohort to Nantong population-based cancer registry and vital statistics database， with the follow-up cut-off date set as December 31， 2025. Lung cancer incident cases and deaths occurring from enrollment to the end of follow-up were extracted. Indicators including high-risk proportion， screening compliance rate， cumulative lung cancer incidence， lung cancer mortality and observed survival rate (OSR) were calculated. Univariate analysis was conducted using the Chi-square test， and multivariate analysis employed Logistic regression. The Kaplan-Meier method was adopted to calculate OSR， the Log-rank test for univariate survival comparison， and Cox proportional hazards regression model for multivariate survival analysis. Variables that were statistically significant in the univariate analysis (P<0.05) were included in the multivariate analysis. ［Results］ A total of 184 852 participants completed lung cancer risk assessment， among whom 74 914 (40.53%) were males and 109 938 (59.47%) were females. A total of 31 655 participants were identified as lung cancer high-risk individuals， corresponding to a high-risk proportion of 17.12%. Among high-risk participants， 15 690 completed low-dose computed tomography (LDCT) screening， with a screening compliance rate of 49.57%. During the follow-up period， 3 250 incident lung cancer cases were identified， with a cumulative incidence of 1.76%， and 979 lung cancer deaths were recorded， with a lung cancer mortality of 0.53%. The 1-， 3-， 5-year OSR of lung cancer patients were 80.26%， 73.75% and 69.62%， respectively. The sensitivity and specificity of the lung cancer risk assessment model used in this study were 31.51% and 83.13%， respectively. Independent risk factors for lung cancer incidence included male， older age， smoking history and history of chronic respiratory diseases (all P<0.05). Independent risk factors for lung cancer-specific mortality included male， older age， unmarried status， low educational level and smoking history (all P＜0.001)； independent adverse prognostic factors for lung cancer survival included male， older age， unmarried status， low educational level and smoking history (all P<0.05). ［Conclusion］ A paradoxically low high-risk prevalence coupled with high lung cancer detection and mortality rates in Nantong City， alongside improved survival rates for diagnosed patients were observed. Male， aging， smoking and history of respiratory diseases are the key target groups for lung cancer prevention and treatment. Efforts should be actively made to carry out public awareness campaigns， enhance residents’ health literacy， foster awareness of early detection and early treatment of lung cancer， and reduce the health and social burden associated with lung cancer treatment. |
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