基于年龄的肺癌监测查在美国
Hee Chul Yang1, Austin Chang1, Maxime Visa1
1Division of Thoracic Surgery, Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA network open
|November 20, 2025
概括
目前的肺癌查指南忽略了许多风险人群,特别是女性和从未吸烟者. 基于年龄的查显著改善了检测,并且更具成本效益,解决了当前指南中的不平等问题.
科学领域:
- 肺部病理学 肺部病理学
- 在瘤学瘤学.
- 公共卫生 公共卫生
背景情况:
- 肺癌越来越多地被诊断为从不吸烟的人.
- 目前美国预防服务特别工作组 (USPSTF) 的查标准可能会排除处于风险的个人,这引发了对有效性和公平性的担忧.
研究的目的:
- 评估符合或不符合USPSTF标准的肺癌患者的比例,特征和生存率.
- 模拟扩展查标准,并评估基于年龄的查.
主要方法:
- 在学术中心对2018-2023年诊断的肺癌患者的分析.
- 按2021年USPSTF资格分层 (年龄50-80,≥20个包年,退休年龄<15年).
- 扩展场景的建模和对乳腺癌和结直肠癌查的基准测试.
主要成果:
- 在997名患者中,只有35.1%符合USPSTF标准.
- 被排除在外的组中有更多的女性,亚洲患者,从未吸烟者和腺癌诊断,生存率更好.
- 扩展标准 (年龄40-85岁,≥10包年,没有戒烟限制) 将检测率提高到62.1%.
- 基于年龄的模拟查 (40-85岁) 捕获了93.9%的病例,并且非常具有成本效益.
结论:
- 目前的USPSTF指南将三分之二的患者排除在外,不成比例地影响女性和从未吸烟者.
- 基于年龄的查显著改善了肺癌的检测,并解决了不平等问题.
- 与现有计划相比,基于年龄的肺癌查显示出更高的成本效益.
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