背景与目的对人群每年进行低剂量胸部CT筛查可提高早期肺癌诊断率,但其假阳性率较高,常导致不必要的手术.本研究拟建立肺癌家系风险度预测模型,从中细分高危人群,从而提高筛选效能.方法以经病理确诊的肺癌患者的家系作为研究人群,同时收集先证者的配偶家系作为对照家系,共收集先证者家系633例和对照家系565例.应用SPSS 17.0进行统计学分析.结果先证者家系一级亲属患肿瘤的风险性为对照组家系一级亲属的1.71倍(OR=1.71,P＜0.001).家系中患癌个数分别为=1和≥2的两组与对照组比较有统计学差异(P=0.005,P=0.002).建立回归模型后赋值得到与普通人群相比的肺癌风险度为0.38-63.08(倍).风险度为普通人群10倍以上的群体,应用本模型的正确率为88.1％.结论如果一级亲属患癌个数越多,患肺癌的风险越高.根据本研究建立的风险度预测模型,风险度达普通人群10倍以上的主要为重度吸烟的吸烟人群,应加强筛查.特点为:有肺部既往疾病史的重度吸烟人群,加上男性、职业暴露和一级亲属肿瘤家族史三项中的任一项；有肺部既往疾病史或重度吸烟的人群中,有职业暴露的男性且一级亲属有不少于两位肿瘤患者.%Background and objective Annual lung screening using spiral computed tomography (CT), has a high sensitivity of detecting early lung cancer (LC), but its high rates of false-positive often lead to unnecessary surgery. The aim of this study is to create a forecasting model of high risk individuals to lung cancer. Methods The pathologic diagnoses of LC in Guangdong Lung Cancer Institute were consecutively chosen as the probands. All the members of the first-degree relatives of probands' and their spouses' were enrolled in this study. These pedigrees consisted of 633 probands' pedigrees and 565 spouses' pedigrees. Unless otherwise stated, analyses were performed using the SPSS 17.0 statistical software package. Results Compared with the control, a family history of carcinoma in first-degree relatives was significantly associated with LC risk (OR= 1.71, P<0.001), the sub-group of either one infected individual or more than two infected individuals in first-degree relatives showed significantly statistical differences (P=0.005, P=0.002). In the forecasting model, the risk compared to that in Chinese population was from 0.38 to 63.08 folds. In the population whose risk was more than 10 times to the Chinese population, the accuracy rate of prediction was 88.1%. Conclusion A family history of carcinoma in first-degree relatives was significantly associated with increased LC risk. The more infected individuals exist in first-degree relatives, the more risk was showed. In the forecasting model, smokers especially heavy ones whose risk were more than 10 times to the Chinese population should be receive annual screening. The population are positive at least any two conditions which including male, lung disease history, occupation expose and history of cancer in first-degree relative.
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