• 四川大學(xué)華西醫(yī)院老年科,成都,610041;

本文對普通胸片、痰細胞學(xué)檢查和低劑量CT在肺癌篩查中的作用以及各種臨床試驗的研究設(shè)計、偏倚等進行了分析,從循證醫(yī)學(xué)角度闡述了單純胸片篩查或聯(lián)合痰脫落細胞學(xué)檢查均不能降低肺癌死亡率;盡管低劑量CT能夠檢測到大多數(shù)無癥狀性肺癌和早期可切除的肺癌,但有過度診斷和研究設(shè)計僅限于觀察性試驗的不足,有待隨機對照試驗的進一步證實.

引用本文： 董碧蓉,何萍. 從循證醫(yī)學(xué)角度談早期肺癌的篩查. 中國循證醫(yī)學(xué)雜志, 2004, 04(6): 419-422. doi: 復(fù)制

1. ［1］Brownson RC, Alavanja MC, Caporaso N, Simoes EJ, Chang JC. Epidemiology and prevention lung cancer in nonsmokers[J]. Epidemlol Rev, 1998; 20(2): 218-236.
2. ［2］Zhang ZQ, Ye S. The prevalence, mortality and survival situation of lung cancer in 1998 [J]. the Medical J of disability,2000; 8(1): 46-47.
3. 張忠清,葉召.1998年肺癌發(fā)病、死亡及生存現(xiàn)狀[J].傷殘醫(yī)學(xué)雜志,2000;8(1):46～47.
4. ［3］Smith IE. Screening for lung cancer time to think positive [J ].Lancet, 1999; 354(9 173): 86-87.
5. ［4］Park BJ, Altorki NK. Diagnosis and management of early lung cancer [J]. Surg Clin North Am, 2002; 82(3): 457-476.
6. ［5］Kuzniar T, Masters GA, Ray DW. Screening for lung cancer-a review [J]. Med Sci Monit, 2004; 10(2): RA21-30.
7. ［6］Bach PB, Kelley MJ, Tate RC, McCrory DC. Screening for lung cancer: a review of the current literature [ J ]. Chest,2003; 123(1 Suppl): 72S-82S.
8. ［7］Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR. Lung cancer screening: the Mayo program [J]. J Occup Med, 1986; 28(28): 746-750.
9. ［8］Black WC, Haggstrom DA, Welch HG. All-cause mortality in randomized trials of cancer screening [J]. J Natl Cancer Inst, 2002; 94(3): 167-173.
10. ［9］Brett GZ. Earlier diagnosis and survival in lung cancer [ J ].BMJ, 1969; 4(478): 260-262.
11. ［10］Tsao H, Feldman M, Fullerton JE, Sober AJ, Rosenthal D,Goggins W. Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival [J]. Arch Dermatol, 2004; 140(1):67-70.
12. ［11］Manser RL, Irving LB, Byrnes G, Abramson MJ, Stone CA,Campbell DA. Screening for lung cancer: a systematic review and meta-analysis of controlled trials [J]. Thorax, 2003; 58(9): 784-789.
13. ［12］Berlin N. Overview of the NCI Cooperative Early Lung Cancer Detection Program [J]. Cancer, 2000; 89(11 Suppl): 2 349-2 351.
14. ［13］Kubik A, Polak J. Lung cancer detection: results of a randomized prospective study in Czechoslovakia [ J ]. Cancer,1986; 57(12): 2 427-2 437.
15. ［14］Brett GZ, The value of lung cancer detection by six-monthly chest radiograhs [J]. Thorax, 1968; 23(4): 414-420.
16. ［15］Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Wuhm JR, Bemaz PE, Payne WS, Pairolero PC,Bergstralh EJ. Screening for lung cancer: a critique of the Mayo Lung Project [J]. Cancer, 1991; 67(4 Suppl): 1 155-1 164.
17. ［16］Tockman MS. Lung cancer screening: the Johns Hopkins study [J]. Chest, 1986; 89(suppl): 324.
18. ［17］Melamed MR. Lung cancer screening results in the National Cancer Institute, New York Study [J]. Cancer, 2000; 89(11 Suppl): 2 356-2 362.
19. ［18］Frost JK, Ball WCJr, Levin ML, Tockman MS, Baker RR,Carter D, EgglestonJC, Erozan YS, Guptu PK, Khouri NF.Early lung cancer detection: results of the initial (pravelence)radiologic and cytologic screening in the Johns Hopkins Study[J]. Am Rev Respir Dis, 1984; 130(4): 549-554.
20. ［19］Bremnes RM, Hirsch FR. Lung cancer screening-what now[J]? Tidsskr Nor Laegeforen, 2001; 121 ( 13 ): 1 600-1 604.
21. ［20］Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamanda T, Kubo K, Hanamura K,Asakura K. Mass screening for lung cancer with mobile spiral computed tomography scanner [J]. Lancet, 1998; 351 (9111) :1 242-1 245.
22. ［21］Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suenasu K, Moriyama N. Peripheral lung cancer: screening and detection with low-dose spiral CT vs radiography [J ].Radiology, 1996; 201(3): 798-802.
23. ［22］Kakinuma R, Ohmatsu H, Kaneko M, Eguchi K, Naruke T, Nagai K, Nishiwaki Y, Suzuki A, Moriyama N. Detection failures in spiral CT screening for lung cancer: analysis of CT findings [J]. Radiology, 1999; 212(1): 61-66.
24. ［23］Henschke CI. Early lung cancer action project: overall design and findings from baseline screening [J]. Cancer, 2000; 89( Suppl 11 ): 2 474-2 482.
25. ［24］Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, Heindel W. Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers [J]. Radiology, 2002; 222(3): 773-781.
26. ［25］Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA,Sykes AM, Aughenbaugh GL, Clemens MA. Lung cancer screening with CT: Mayo Clinic experience [J]. Radiology,2003; 226(3): 756-761.
27. ［26］Li TY, Bai YX, Gao YA. Using X-ray early diagnosis for broncho-pulmonary cancer [ M ]. 1st Edition, Beijing: Liberation army publishing house, 1986.
28. 李鐵一,白友賢,高育傲.早期支氣管肺癌X線診斷[M].第1版,北京:解放軍出版社,1986.
  1. 1. ［1］Brownson RC, Alavanja MC, Caporaso N, Simoes EJ, Chang JC. Epidemiology and prevention lung cancer in nonsmokers[J]. Epidemlol Rev, 1998; 20(2): 218-236.
  2. 2. ［2］Zhang ZQ, Ye S. The prevalence, mortality and survival situation of lung cancer in 1998 [J]. the Medical J of disability,2000; 8(1): 46-47.
  3. 3. 張忠清,葉召.1998年肺癌發(fā)病、死亡及生存現(xiàn)狀[J].傷殘醫(yī)學(xué)雜志,2000;8(1):46～47.
  4. 4. ［3］Smith IE. Screening for lung cancer time to think positive [J ].Lancet, 1999; 354(9 173): 86-87.
  5. 5. ［4］Park BJ, Altorki NK. Diagnosis and management of early lung cancer [J]. Surg Clin North Am, 2002; 82(3): 457-476.
  6. 6. ［5］Kuzniar T, Masters GA, Ray DW. Screening for lung cancer-a review [J]. Med Sci Monit, 2004; 10(2): RA21-30.
  7. 7. ［6］Bach PB, Kelley MJ, Tate RC, McCrory DC. Screening for lung cancer: a review of the current literature [ J ]. Chest,2003; 123(1 Suppl): 72S-82S.
  8. 8. ［7］Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR. Lung cancer screening: the Mayo program [J]. J Occup Med, 1986; 28(28): 746-750.
  9. 9. ［8］Black WC, Haggstrom DA, Welch HG. All-cause mortality in randomized trials of cancer screening [J]. J Natl Cancer Inst, 2002; 94(3): 167-173.
  10. 10. ［9］Brett GZ. Earlier diagnosis and survival in lung cancer [ J ].BMJ, 1969; 4(478): 260-262.
  11. 11. ［10］Tsao H, Feldman M, Fullerton JE, Sober AJ, Rosenthal D,Goggins W. Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival [J]. Arch Dermatol, 2004; 140(1):67-70.
  12. 12. ［11］Manser RL, Irving LB, Byrnes G, Abramson MJ, Stone CA,Campbell DA. Screening for lung cancer: a systematic review and meta-analysis of controlled trials [J]. Thorax, 2003; 58(9): 784-789.
  13. 13. ［12］Berlin N. Overview of the NCI Cooperative Early Lung Cancer Detection Program [J]. Cancer, 2000; 89(11 Suppl): 2 349-2 351.
  14. 14. ［13］Kubik A, Polak J. Lung cancer detection: results of a randomized prospective study in Czechoslovakia [ J ]. Cancer,1986; 57(12): 2 427-2 437.
  15. 15. ［14］Brett GZ, The value of lung cancer detection by six-monthly chest radiograhs [J]. Thorax, 1968; 23(4): 414-420.
  16. 16. ［15］Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Wuhm JR, Bemaz PE, Payne WS, Pairolero PC,Bergstralh EJ. Screening for lung cancer: a critique of the Mayo Lung Project [J]. Cancer, 1991; 67(4 Suppl): 1 155-1 164.
  17. 17. ［16］Tockman MS. Lung cancer screening: the Johns Hopkins study [J]. Chest, 1986; 89(suppl): 324.
  18. 18. ［17］Melamed MR. Lung cancer screening results in the National Cancer Institute, New York Study [J]. Cancer, 2000; 89(11 Suppl): 2 356-2 362.
  19. 19. ［18］Frost JK, Ball WCJr, Levin ML, Tockman MS, Baker RR,Carter D, EgglestonJC, Erozan YS, Guptu PK, Khouri NF.Early lung cancer detection: results of the initial (pravelence)radiologic and cytologic screening in the Johns Hopkins Study[J]. Am Rev Respir Dis, 1984; 130(4): 549-554.
  20. 20. ［19］Bremnes RM, Hirsch FR. Lung cancer screening-what now[J]? Tidsskr Nor Laegeforen, 2001; 121 ( 13 ): 1 600-1 604.
  21. 21. ［20］Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamanda T, Kubo K, Hanamura K,Asakura K. Mass screening for lung cancer with mobile spiral computed tomography scanner [J]. Lancet, 1998; 351 (9111) :1 242-1 245.
  22. 22. ［21］Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suenasu K, Moriyama N. Peripheral lung cancer: screening and detection with low-dose spiral CT vs radiography [J ].Radiology, 1996; 201(3): 798-802.
  23. 23. ［22］Kakinuma R, Ohmatsu H, Kaneko M, Eguchi K, Naruke T, Nagai K, Nishiwaki Y, Suzuki A, Moriyama N. Detection failures in spiral CT screening for lung cancer: analysis of CT findings [J]. Radiology, 1999; 212(1): 61-66.
  24. 24. ［23］Henschke CI. Early lung cancer action project: overall design and findings from baseline screening [J]. Cancer, 2000; 89( Suppl 11 ): 2 474-2 482.
  25. 25. ［24］Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, Heindel W. Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers [J]. Radiology, 2002; 222(3): 773-781.
  26. 26. ［25］Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA,Sykes AM, Aughenbaugh GL, Clemens MA. Lung cancer screening with CT: Mayo Clinic experience [J]. Radiology,2003; 226(3): 756-761.
  27. 27. ［26］Li TY, Bai YX, Gao YA. Using X-ray early diagnosis for broncho-pulmonary cancer [ M ]. 1st Edition, Beijing: Liberation army publishing house, 1986.
  28. 28. 李鐵一,白友賢,高育傲.早期支氣管肺癌X線診斷[M].第1版,北京:解放軍出版社,1986.