首页 中华肿瘤杂志 2021年43卷03期 中国肺癌筛查与早诊早治指南(2021,北京)
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中国肺癌筛查与早诊早治指南(2021,北京)
赫捷 
李霓
陈万青
吴宁
沈洪兵
江宇
李江
王飞
田金徽
中国肺癌筛查与早诊早治指南制定顾问组
中国肺癌筛查与早诊早治指南制定专家组
中国肺癌筛查与早诊早治指南制定工作组
作者及单位信息
·
DOI： 10.3760/cma.j.cn112152-20210119-00060
China guideline for the screening and early detection of lung cancer(2021, Beijing)
He Jie
Li Ni
Chen Wanqing
Wu Ning
Shen Hongbing
Jiang Yu
Li Jiang
Wang Fei
Tian Jinhui
Consulting Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
Expert Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
Working Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
Authors Info & Affiliations
He Jie
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li Ni
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Chen Wanqing
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Wu Ning
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Shen Hongbing
Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
Jiang Yu
School of Public Health and Population Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Li Jiang
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Wang Fei
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Tian Jinhui
Evidence Based Medicine Center of Lanzhou University, Lanzhou 730000, China
Consulting Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
Expert Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
Working Group of China Guideline for the Screening and Early Diagnosis and Treatment of Lung Cancer
·
DOI： 10.3760/cma.j.cn112152-20210119-00060
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摘要
肺癌是中国发病率和死亡率最高的恶性肿瘤。筛查与早诊早治是降低人群肺癌死亡率的有效措施。制定符合中国国情的肺癌筛查与早诊早治指南，将极大推进中国肺癌筛查的同质性和优质性，提高肺癌筛查的效果。指南受国家卫生健康委员会疾病预防控制局委托与指导，由国家癌症中心发起，联合多学科专家共同制定。指南整合近年来国内外在肺癌筛查与早诊早治方面的新进展，同时考虑中国国情和肺癌筛查的实际经验，根据世界卫生组织指南制定手册的原则和方法，针对肺癌筛查过程中的筛查人群、技术、流程等给出了详细的循证推荐，旨在规范肺癌筛查与早诊早治实践，提升中国肺癌防控效果。
肺肿瘤;筛查;指南
ABSTRACT
In China, the malignant tumor with the highest incidence and motality is lung cancer (LC). As screening and early detection and treatment are effective in reducing LC mortality, formulating a guideline in line with China′s national conditions for the screening and early detection and treatment of LC will greatly promote the homogeneity and accuracy of LC screening, and result in an improvement of the effectiveness of LC screening. Commissioned and directed by the Disease Prevention and Control Bureau of the National Health Commission of the People′s Republic of China, the guidline was initiated by the National Cancer Center of China and formulated with joint effort by experts from different disciplines. Following the principles and methods in WHO Handbook for Guideline Development, the guidline integrates the latest development in LC screening and early diagnosis and treatment worldwide while fully considering China′s national conditions and practical experience in LC screening. It provides detailed evidence-based recommendations for different aspects of LC screening, such as the targeted population, the technologies and the procedures, to regulate the practices of LC screening and early diagnosis and treatment and enhance the effectiveness of the prevention and control of LC in China.
Lung neoplasms;Screening;Guideline
He Jie, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China, Email:
nc.defcaab.smaciceijeh
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引用本文
赫捷,李霓,陈万青,等. 中国肺癌筛查与早诊早治指南(2021,北京)[J]. 中华肿瘤杂志,2021,43(03)：243-268.
DOI:10.3760/cma.j.cn112152-20210119-00060PERMISSIONS
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一、引言
恶性肿瘤是威胁我国居民生命健康的重大慢性疾病。2015年中国肿瘤登记数据显示，我国恶性肿瘤新发病例约392.9万，死亡病例约233.8万
[
1
]。恶性肿瘤负担呈现逐年上升趋势，防控形势日益严峻。而所有恶性肿瘤中，肺癌的发病率和死亡率均位居首位
[
1
]。2000—2011年，中国男性和女性的肺癌发病与死亡总数均呈持续增高趋势
[
2
]。GLOBOCAN 2020数据显示，中国肺癌发病数和死亡数分别占全球的37.0%和39.8%
[
3
]，肺癌防治是我国恶性肿瘤防控面临的重大挑战。
我国肺癌病例的发现以临床晚期居多。2012—2014年，中国ⅢA～Ⅳ期肺癌的占比为64.6%
[
4
]。我国肺癌年龄标化5年生存率在2003—2015年间略有上升，但仍不超过20.0%，总体5年生存率偏低
[
5
]。肺癌患者的生存时间与其临床诊断发现的早晚密切相关。有研究显示，肺癌5年生存率随着诊断分期的升高而降低，Ⅰ期患者的5年生存率为55.5%，而Ⅳ期仅为5.3%
[
6
]。国内外证据表明，对肺癌高风险人群进行低剂量螺旋CT(low-dose computed tomography, LDCT)筛查，可以早期发现肺癌，改善预后，降低肺癌死亡率。2005年起，我国相继开展多项包含肺癌筛查在内的国家重大公共卫生服务专项，如农村癌症早诊早治项目和城市癌症早诊早治项目
[
7
,
8
]，逐步建立起我国肺癌筛查和早诊早治工作网络，切实提高了我国居民肺癌筛查参与率和早诊率，降低了死亡率。
在加快推进"健康中国行动"战略背景下，国务院明确提出要加强恶性肿瘤早期筛查，制定推广技术指南，有序扩大筛查范围，努力使居民少患癌、不患癌，提高生活质量
[
9
]。国家癌症中心积极践行国家癌症防控战略部署并推进恶性肿瘤筛查与早诊早治工作。然而，各地区医疗水平的差异以及缺乏统一的肺癌筛查技术规范等现状，制约着我国肺癌筛查与早诊早治工作的效果与收益。
为了推进我国肺癌筛查服务的规范化、均质化和优质化，本指南基于肺癌筛查专家共识、国内外肺癌筛查指南规范、大型肺癌筛查项目经验及我国实际国情，结合肺癌筛查相关研究进展，重点针对高风险人群、筛查技术、筛查流程、筛查组织要求及筛查结果管理等方面进行归纳整合，提出适合我国肺癌高风险人群的筛查推荐意见，为流行病学、影像科、呼吸科、胸外科、肿瘤科、病理科等相关学科的医师及工作人员，尤其是基层医务人员提供科学的、适用的、可操作性强的肺癌筛查指导。
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备注信息
A
赫捷，国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院胸外科，100021，Email：
nc.defcaab.smaciceijeh
B
感谢以下专家在本指南制定过程中提出的宝贵建议(按姓氏汉语拼音字母排序)：曹骥、曹素梅、董栋、董华、樊永祥、郭威、何美、贺宇彤、黄立敏、姜晶、姜文珍、金晨望、雷林、李博、罗鹏飞、马洁、彭绩、史纪元、宋述名、孙喜斌、王慜杰、王宁、王亚希、魏葆珺、魏东华、魏清风、席云峰、严俊、叶兆祥、杨莉、于连政、张敏、郑莹、周金意、朱陈
C
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