低剂量计算机断层扫描（LDCT）对亚洲不吸烟女性的肺癌检测相比于亚洲长期吸烟男性效能相同：一项系统回顾和荟萃分析

SCI 7 March 2023

Low dose computed tomography (LDCT) screening in Asian female never-smokers is as efficacious in detecting lung cancer as in Asian male-ever-smokers: a systematic review and meta-analysis 

(Journal of thoracic oncology, IF: 20.121 )

Triphuridet N, Zhang SS, Nagasaka M, Gao Y, Zhao JJ, Syn NL, Hanaoka T, Ou SI, Shum E. Low dose computed tomography (LDCT) screening in Asian female never-smokers is as efficacious in detecting lung cancer as in Asian male-ever-smokers: a systematic review and meta-analysis. J Thorac Oncol. 2023 Feb 10:S1556-0864(23)00124-7. doi: 10.1016/j.jtho.2023.01.094. Epub ahead of print. PMID: 36775191.

Corresponding author 

Sai-Hong Ignatius Ou, MD PhD 

Chao Family Comprehensive Cancer Center 

University of California Irvine School of Medicine 

Department of Medicine, Division of Hematology/Oncology 

200 South Manchester Ave, Suite 400 

Orange, CA 92868, USA 

e-mail: siou@hs.uci.edu

Introduction 引言  

Lung cancer in never-smokers is the major cancer cause of death globally. We compared the efficacy of low-dose computed tomography (LDCT) lung cancer screening among never-smokers versus ever-smokers using systematic review and meta-analysis.

在全球范围内，不吸烟者中肺癌是主要的癌症死因。我们通过系统回顾和荟萃分析比较了低剂量计算机断层扫描（LDCT）肺癌筛查在不吸烟者和长期吸烟者中的效果。

Methods 方法  

LDCT lung cancer screening studies simultaneously included both ever-smoker and never-smoker participants published by April 30, 2021 were searched via Pubmed/Scopus. Primary outcome measure was relative risk (RR) of lung cancer diagnosed among never-smokers versus ever-smokers.

通过Pubmed/Scopus检索截至2021年4月30日发表的同时包括长期吸烟者和不吸烟者的LDCT肺癌筛查研究。主要结果测定为不吸烟者与长期吸烟者肺癌诊断的相对危险度（RR）。

Results 结果  

Fourteen studies (13 from Asia) were included (141,396 ever-smokers, 109,251 never-smokers, 1961 lung cancer cases diagnosed). RR of lung cancer diagnosed between ever-smokers versus never-smokers overall was 1.21 (95%CI: 0.89 - 1.65), 1.37 (95%CI: 1.08 - 1.75) among males, and 0.88 (95%CI: 0.59 - 1.31) among females. RR was 1.78 (95%CI: 1.41 - 2.24) and 1.22 (95%CI: 0.89 - 1.68) for Asian female never-smokers versus male never-smokers and versus male ever-smokers respectively, and 0.99 (95%CI: 0.65 - 1.50) versus high-risk ever-smokers (≥30 pack-years). Proportional meta-analysis showed significantly more lung cancers diagnosed at first scan (95.4% {95%CI: 84.9 - 100.0} versus 70.9% {95%CI: 54.6 - 84.9}, P = 0.010) and at stage 1 (88.5% {95%CI: 79.3 - 95.4} versus 79.7% {95%CI: 71.1 - 87.4}, P = 0.071) among never-smokers versus ever-smokers, respectively. RR of lung-cancer death and 5-years all-cause mortality in never-smokers versus ever-smokers was 0.27 (95%CI: 0.1 - 0.55, p<0.001), and 0.13 (95%CI: 0.05 - 0.33) respectively.

纳入了14项研究（13项来自亚洲）（141,396例长期吸烟者，109,251例不吸烟者，1961例肺癌确诊病例）。长期吸烟者与不吸烟者之间肺癌诊断的RR为1.21（95%CI: 0.89 - 1.65），男性为1.37 (95%CI: 1.08 - 1.75)，女性为0.88 (95%CI: 0.59 - 1.31)。亚洲女性不吸烟者与男性不吸烟者和男性长期吸烟者的RR分别为1.78 (95%CI: 1.41 - 2.24)和1.22 (95%CI: 0.89 - 1.68)，与高危长期吸烟者(≥30包年)的RR为0.99 (95%CI: 0.65 - 1.50)。比例荟萃分析显示，不吸烟者相较于长期吸烟者在初次扫描时肺癌诊断率明显更高(95.4% {95%CI: 84.9 - 100.0}对70.9% {95%CI: 54.6 - 84.9}， P = 0.010和在1期的为88.5% {95%CI: 79.3 - 95.4}对79.7% {95%CI: 71.1 - 87.4}， P = 0.071)。不吸烟者与长期吸烟者肺癌死亡和5年全因死亡率的RR分别为0.27 (95%CI: 0.1 - 0.55, p<0.001)和0.13 (95%CI: 0.05 - 0.33)。

Conclusions 结论  

The RR of lung cancer detected by LDCT screening among female never-smokers and male ever-smokers in Asia was statistically similar. Mortality from the lung cancer diagnosed was significantly reduced among never-smokers versus ever-smokers.

亚洲地区女性不吸烟者和男性长期吸烟者肺癌的LDCT扫描检测RR具有统计学上的相似性。与长期吸烟者相比，不吸烟者被诊断出肺癌的死亡率显著降低。

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