Epidemiological characteristics and risk factors of lung cancer in a population with incidental pulmonary nodules in China: a prospective multicenter study of 10,560 cases.
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Liang Wenhua, Zhou Yongzhao, Hu Chengping, Xiao Wei, Zhang Jian, Li Min, Wang Wei, Ye Xianwei, Zhang Xiangyan, Chang Ning, Yun Chunmei, Sun Dejun, Zhang Yunhui, Qin Zheng, Wang Wei, Zhang Yong, Zhang Xin, Xiang Yi, Qu Jieming, Zhang Wei, Sun Longhua, Hu Yang, Xu Jinfu, Wu Di, Zhao Jianping, Zhang Xiaoju, Bao Hairong, Liu Xiaoju, Guo Yubiao, Li Zhanqing, Zhang Qichuan, Zhu Weiyi, Yang Lan, Dang Xiaomin, Han Baohui, Tong Zhaohui, Wang Feng, Liu Liping, Peng Minhua, Wu Shuangxiu, Zeng Liuhong, Teng Lin, Qiu Xiangcheng, Wang Bo, Tao Jinsheng, Yang Meng, Zhao Junjie, Chen Silvia S, Fan Jianbing, Li Weimin, Liu Dan, He Jianxing, Zhong Nanshan
Аннотация
METHODS: A total of 10,560 participants with 5-30 mm pulmonary nodules incidentally detected via low-dose computed tomography (LDCT)/CT were enrolled from 23 hospitals (October 2018-May 2021) and followed for 2-3 years for evaluation of circulating tumor DNA (ctDNA) biomarkers to distinguish malignant and benign nodules. Demographic, clinical, and imaging data were collected and analyzed. Lung cancer risk factors were assessed using stepwise single and multiple-factor binary logistic regression. This study reports only the baseline epidemiological characteristics of the population and the associated risk factors of lung cancer.
RESULTS: A higher proportion of females (56.56%) were present across all age groups, with a median age of 53 years (45-62), younger than males (55 years [46-63], P < 0.001). While 97.1% of females and 37.8% of males were non-smokers, and 68.65% of participants had no occupational exposure, 71.10% had a history of second-hand smoke exposure. Most nodules were solitary (81.24%), sub-centimeter (78.22%), and non-solid (62.49%). Malignancy was identified in 17.33% of nodules, with 97.32% classified as early-stage lung adenocarcinoma (AJCC stage 0-I: 90.35%). The malignant rate increased with age and nodule size and was also associated with multiple nodules, ground-glass nodules (GGNs), upper lobe location, and female sex. Proportion of patients with malignant nodules was similar between non-high-risk (21.04%) and high-risk (17.92%) groups based on current Chinese screening guidelines, while proportions of benign nodules were notably high for solid nodules (37.21%) and small nodules (20.15%).
CONCLUSION: Our large-scale investigation provides updated data to guide future precise clinical management of pulmonary nodules, with a particular focus on younger females and reducing overtreatment.