Background: Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice.
Methods: The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China.
Results: Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation.
Conclusions: A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
背景与目的 肺癌是导致中国癌症死亡的首要原因。已有的研究证明低剂量螺旋CT在肺癌高危人群进行肺癌筛查能降低20%的肺癌死亡。本研究的目的是建立适合中国国情的肺癌筛查指南。方法 由国家卫计委任命的中国肺癌早诊早治专家组专家及部分非专家组专家，包括：4名胸外科专家、4名胸部影像学专家、2名肿瘤学专家、2名肺内科专家、2名病理学专家和2名流行病学专家，共同参与了本指南的制定工作。专家们在系统评价了美国NLST和中国农村肺癌LDCT筛查结果及经验，并达成共识的基础上，共同推荐了本肺癌筛查指南。结果 本指南推荐的肺癌高危人群为：年龄50岁-74岁；吸烟20包/年，或者戒烟5年。参与肺癌LDCT筛查前，需要获得筛查者的知情同意。肺癌筛查需与健康教育结合，向患者宣传吸烟对健康的危害。因此，健康教育应该整合到肺癌筛查全过程，以便帮助患者戒烟。结论 LDCT筛查能降低肺癌死亡率，本指南推荐中国肺癌高危人群进行LDCT筛查。但是，未来需要进行更多的研究，包括LDCT联合生物标志物用于肺癌筛查的研究，以优化肺癌LDCT筛查方法及技术。.
Keywords: Guideline; High risk population; LDCT; Lung neoplasms; Screening.