13001340 肺癌早期诊断与筛查 (刘权).ppt

Case 1 55-year-old man Nodule detected by a screen Silice thickness 5mm Small MPR 居灶性间质纤维化 细支气管肺泡癌 腺癌和不典型增生 嗜酸细胞性肺炎 局灶性间质纤维化 细支气管肺泡癌 细支气管肺泡癌为主的腺癌 混合型磨玻璃样结节 80％以上为癌 肺癌发生率: 磨玻璃样结节（GGO）: (73%) 混合型GGO ：63~ 89.6% 单纯GGO 18~38% 不典型腺瘤样增生：癌前病变，病理上1cm 肺结节的随访 对不能定性的结节随访观察非常重要 炎性病变：自发吸收或抗炎治疗后吸收 3年后 02年 6年后（08年） AC 80,y, m After 12 months After 16 months AC 恶性结节病变增大一倍的时间为30～400天 倍增时间大于600天，恶性概率很低 大多数结节一般来说结节在两年内未观察到生长，可视为良性 肿瘤也可表现为一个S形的生长方式，即在一段相当长的时期内无明显生长，然后突然出现生长加速 BAC和类癌偶尔可稳定2年甚至更长时间 肺癌早期筛查 肺癌的早期发现只能通过健康体检和肺癌普查 高危人群 年龄范围50岁～80岁、无临床症状(不断恶化的咳嗽、痰血、不明原因体重减轻) 吸烟史：≥20 pack-years（pack-years被定义为每天吸烟的包数x年数），其中包括曾经吸烟，但戒烟时间不到5年 近5年无癌症病史（非黑色素性皮肤癌、宫颈原位癌、局限性前列腺癌除外） 能够承受可能的肺部手术 无严重的影响生命的疾病。 普查结果 肺癌检出率：1～2% ⅠA期肺癌占79.1~85.1% 5年生存率90％以上 International Eerly Lung Cancer Action ProgramI-ELCAP Mission early diagnosis, treatment, and ultimate cure of lung cancer International, collaborative group Experts on lung cancer and related issues from around the world Background 1991，Weill Medical College of Cornell University 1992, ELCAP (Early Lung Cancer Action Program) was born First conferrence: Oct,1999, Weill Medical College of Cornell University, NY Annual CT screening allows at least 80% of lung cancers to be diagnosed at Stage I 85%, 23/25,LANCET,1999 IA(2cm)，80% Cancer 2001 Curability Stage I lung cancers 80~90% Publications International Early Lung Cancer Action Program Investigators. Survival of Patients with Stage I Lung Cancer Detected on CT Screening. New England Journal of Medicine 2006; 355:1763-1771 International Early Lung Cancer Action Program Investigators. Womens susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer. JAMA 2006; 296:180-184 The International Early Lung Cancer Action Program Investigators. CT Screening for Lung Cancer: The relationship of disease stage to tumor size. Archives of Internal Medicine 2006; 166: 321-325 Totally more than 40 articles National Lung Screening Trial (NLST) National Cancer Institute(2002-20