精彩回顾

 

由国际肺癌研究协会（IASLC）主办的2025年世界肺癌大会（WCLC2025）于2025年9月9日在西班牙巴塞罗那圆满闭幕。作为肺癌及其他胸部恶性肿瘤领域全球领先的多学科肿瘤学盛会，本次大会吸引了来自世界各地的众多专家学者参会，围绕肺癌及其他胸部恶性肿瘤的前沿诊疗进展展开了深入探讨。

 

大会特设“Highlights of the Day”专场，旨在回顾当日领域重磅研究进展，为全球肺癌领域研究者提供了聚焦当日核心进展的高效途径，以便快速捕捉研究动态、同步前沿认知。在会议现场，《肿瘤瞭望》特邀“肺癌筛查”领域“Highlights of the Day”专场汇报者中国台湾大学医学院杨泮池教授接受专访，回顾WCLC肺癌筛查领域重磅研究进展，特此整理，以飨读者。

 

专家简介

 

 

杨泮池教授：9月8日的“Highlight of the Day”专场，我分享了三项肺癌筛查相关报告，分别来自克罗地亚（摘要号：OA15.01）、新加坡（摘要号：OA15.02）以及美国（摘要号：OA15.03）——其中美国的FANSS研究专门针对亚裔美国非吸烟女性群体开展肺癌筛查。

 

最重要的研究结果来自新加坡和美国这两项研究，因为它们均以亚洲人群为研究对象。我们知道，肺癌是全球癌症死亡的首要原因，而亚洲承担着最高的疾病负担，全球约52%的肺癌病例和53%的肺癌死亡病例都发生在亚洲。

 

亚洲人群的肺癌病例与白种人群存在显著差异。值得注意的是，亚洲非吸烟者中肺癌患病率更高，女性群体尤为突出。尽管在亚洲各国，肺癌都是女性癌症死亡的首要原因，但大多数亚洲国家的女性吸烟率却极低，例如中国女性吸烟率仅约5%，韩国和新加坡的女性吸烟率也处于类似低水平。这一现象表明，鉴于非吸烟相关肺癌病例数量不断增加，亚洲女性可能对肺癌的致癌作用更易感。因此，针对这一群体开展肺癌筛查已成为当务之急。

 

这两项筛查研究均以女性为研究对象。新加坡的研究沿用了TALENT研究的设计方案，将研究对象分为两组：一组是重度吸烟者，另一组是非吸烟者或轻度吸烟者且有肺癌家族史（与TALENT研究的分组完全一致）。该研究目前已筛查了420名参与者，总体肺癌检出率高达1.9%，这一结果十分显著。且检出的肺癌病例大多来自非吸烟群体。奇怪的是，这些非吸烟患者存在磨玻璃结节，而我们无法用标准诊断标准在低剂量CT扫描中识别出这些异常结节。因此，这项研究给出了一个关键启示：针对亚洲人群的肺癌诊断标准可能与针对白种人群的标准不同，筛查策略也需据此调整。

 

另一项研究由纽约的研究人员牵头开展，研究对象为亚裔美国女性。该研究未将家族史作为筛查标准，仅纳入亚裔女性（其中大部分人从中国及其他东亚国家移民至美国）。研究共筛查了1000名参与者，肺癌检出率仍高达1.3%，这一数值高于Nelson研究及其他针对重度吸烟者的研究中报告的检出率。这表明，即便移民至美国的亚裔后代，其肺癌患病风险依然较高，这提示遗传易感性可能在其中发挥关键作用。我们同时推测，环境空气污染也可能是导致亚洲人群非吸烟相关肺癌发病率较高的原因之一。

 

Prof.Pan-Chyr Yang:Sure.Actually，I’m responsible for the September 8th"Highlight of the Day"session.My role is to highlight three presentations on lung cancer screening—one from Croatia，another from Singapore，and the last one from the United States which is specifically a lung cancer screening study for female Asian American never-smokers.

 

The most significant findings come from the two studies，both the Singaporean one and the U.S.onefocus on the Asian population.We know lung cancer is the leading cause of cancer mortality worldwide，but Asia bears the highest disease burden:around 52%of all lung cancer cases and 53%of lung cancer mortality occur in Asia.

 

Asian lung cancer cases differ quite a bit from those in Caucasians.Notably，there’s a higher prevalence of lung cancer in non-smokers，especially among women.While lung cancer is the top cause of cancer deaths in women across Asia，smoking rates among women in most Asian countries are very low—for example，only around 5%in China，and similarly low in South Korea and Singapore.This suggests Asian women may have higher susceptibility to carcinogenesis of the lung cancer，given the rising number of non-smoking-related lung cancer cases.This makes lung cancer screening for this group an urgent priority.Both of these two screening studies focus on women.The Singaporean study follows the TALENT Study design and targets two groups:heavy smokers，and non-smokers or light smokers with a family history of lung cancer(exactly like the TALENT Study).They’ve screened 420 participants so far，and the overall lung cancer detection rate is as high as 1.9%—which is very notable.Most of these cases are in non-smokers.Strangely，these non-smoking patients had ground-glass nodules，and we can’t use standard criteria to detect these abnormal nodules on low-dose CT scans.So this study provides crucial insight:diagnostic criteria for Asian populations may differ from those for Caucasians，and screening strategies may need to be adjusted accordingly.The other study，led by researchers in New York，focuses on Asian American women.It didn’t include family history as a screening criterion—instead，it only included women of Asian descent，most of whom immigrated from China and other East Asian countries.They screened 1，000 participants，and the lung cancer detection rate was still as high as 1.3%—higher than rates reported in the Nelson Study or other studies focusing on heavy smokers.This indicates that even Asian descendants who’ve immigrated to the U.S.still face a high risk of lung cancer，suggesting genetic susceptibility may play a key role.We also suspect environmental air pollution may contribute to the higher rate of non-smoking-related lung cancer in Asian populations.

 

杨泮池教授：事实上，当前最主要的障碍在于说服各国政府及相关主管部门。我们需要让他们认识到，既然肺癌是癌症死亡的首要原因，那么通过筛查在疾病早期（可治愈阶段）发现病灶，或许是防控肺癌最有效的手段。

 

另一个障碍是消除社会偏见，尤其是针对非吸烟却患肺癌的人群的偏见。患者倡导在此过程中至关重要，当患者分享自身经历时，能帮助公众理解肺癌筛查对于在疾病可治愈阶段发现病情的重要性。

 

Prof.Pan-Chyr Yang:Actually，the most important obstacle is convincing governments and authorities.We need to make them recognize that since lung cancer is the leading cause of cancer mortality，screening to detect lesions in the early，curable stages is likely the most effective way to control lung cancer.

 

Another obstacle is addressing the stigma—especially for people who develop lung cancer despite never smoking.Patient advocacy is crucial here:when patients share their personal experiences，it helps the general public understand that lung cancer screening is vital for detecting the disease in its curable stages.

 

杨泮池教授：许多国家，尤其是高收入和中高收入国家，已实施戒烟项目，且多数项目成效显著。从数据来看，大多数高收入和中高收入国家的吸烟率正逐步下降。假以时日，随着吸烟相关肺癌发病率的降低，非吸烟相关肺癌病例在肺癌总病例中的占比将相对上升。

 

Prof.Pan-Chyr Yang:Smoking cessation programs have been implemented in many countries，especially high-income and upper-middle-income ones—and most of these programs have been quite successful.You can see smoking prevalence declining in most high-income and upper-middle-income countries.Over time，this will lead to a relative increase in non-smoking-related lung cancer cases，as smoking-related lung cancer incidence decreases.

 

杨泮池教授：近年来随着技术进步已显著优化了肺癌筛查策略，尤其是人工智能（AI）技术能帮助我们更准确、更高效地解读低剂量CT筛查影像。AI不仅能辅助放射科医生更轻松地生成诊断报告，还能为他们节省大量时间。此外，近年来研发的算法（如SYMPLIFY算法）可帮助我们评估受检者未来6年内的肺癌发病风险。基于这一风险评估结果，我们能够调整筛查间隔：对于非吸烟相关肺癌，由于肿瘤生长速度极慢，目前我们采用每两年一次的CT筛查方案；但对于经AI判定为低风险的受检者，我们或许可以将筛查间隔延长至3年、4年，甚至5年。

 

另一类重要技术与生物标志物相关，例如循环肿瘤细胞（CTCs）、循环肿瘤DNA（ctDNA）以及蛋白质组学生物标志物。然而，目前多数生物标志物在检测早期肺癌病灶时灵敏度较低，因此它们现阶段仅可用于病情确认，无法在筛查项目中用于肺癌早期检测。

 

Prof.Pan-Chyr Yang:We all know that recent technological advances，especially AI can help us interpret low-dose CT screening scans more accurately and efficiently.AI assists radiologists in generating reports more easily and saves them a lot of time.Additionally，recent algorithms(such as SYMPLIFY)can help us identify the risk of developing lung cancer over the next 6 years.This allows us to adjust screening intervals:for non-smoking-related lung cancer，tumors grow very slowly，so we currently use biennial CT scans(once every 2 years).But for low-risk participants identified by AI，we might extend the screening interval to 3，4，or even 5 years.

 

Another area is biomarkers—such as circulating tumor cells(CTCs)，circulating tumor DNA(ctDNA)，and proteomic biomarkers.However，most of these biomarkers still have low sensitivity for detecting early-stage(Stage I)lung cancer lesions.So currently，they can only be used for confirmation，not for early detection in screening programs.

 

杨泮池教授：目前，大多数肺癌患者在确诊时已处于疾病晚期。以中国台湾地区为例，许多患者确诊时已为Ⅳ期肺癌，而Ⅳ期肺癌患者的5年生存率极低，仅约15%至20%。但如果肺癌能在Ⅰ期（尤其是ⅠA期）确诊，患者的5年生存率可超过90%，且这类患者甚至可能无需后续接受化疗、免疫治疗或靶向治疗。这不仅能大幅节省医疗费用，还能避免患者承受化疗、免疫治疗或靶向治疗等强化治疗带来的副作用。

 

若要评估肺癌筛查的成本效益，可参考以下对比：用于治疗晚期肺癌的第三代酪氨酸激酶抑制剂（TKI），其单片价格与一次CT检查费用大致相当。对于晚期肺癌患者，需每日服用该药物，直至疾病复发；而一片这样的药物，其费用便足以覆盖一次CT检查的成本。通过这一对比不难看出，肺癌筛查具有极高的成本效益。当然，在推行肺癌筛查项目时，我们也需考虑各国当地的经济状况。

 

Prof.Pan-Chyr Yang:Well，most lung cancer patients are diagnosed at an advanced stage.For example，many patients are diagnosed with Stage IV disease in Taiwan，China.And the 5-year survival rate for Stage IV lung cancer is very low，around 15%to 20%.But if lung cancer is diagnosed at Stage I(especially Stage IA)，the 5-year survival rate exceeds 90%—and patients may not even need subsequent chemotherapy，immunotherapy，or targeted therapy.This not only saves a lot of medical costs but also spares patients from the side effects of intensive treatments like chemotherapy，immunotherapy，or targeted therapy.

 

To assess the cost-effectiveness:consider that one tablet of a third-generation tyrosine kinase inhibitor(a targeted drug used for advanced lung cancer)costs roughly the same as one CT scan.For advanced disease，patients need to take this drug daily until relapse—but one such tablet could cover the cost of a CT scan.This comparison makes it clear that screening is very cost-effective.Of course，we also need to consider the local economic conditions of each country when implementing screening programs.

 

杨泮池教授：在2025WCLC大会上，我们还将启动国际肺癌研究协会（IASLC）与Lancet委员会联合倡议。该倡议以肺癌综合管理为核心，虽涵盖晚期肺癌治疗议题，但首要重点在于推动两项关键工作：一是实现肺癌的早期确诊，即在疾病尚处于可治愈阶段时检出病灶；二是向疾病预防方向转型，深入探究非吸烟人群肺癌的危险因素，例如空气污染等环境因素均在研究范畴之内。

 

国际肺癌研究协会应采取行动，将其关注重点从精准治疗拓展至早期检测与预防领域。我们的目标是在全球范围内降低肺癌死亡率。

 

Prof.Pan-Chyr Yang:At WCLC 2025，we will also launch the IASLC and Lancet Commission initiative.This initiative focuses on comprehensive lung cancer management—including treatment for advanced disease—but its top priorities are diagnosing lung cancer in the early，curable stages，and shifting toward prevention:understanding why non-smoking individuals develop lung cancer(for example，air pollution may play a role).

 

The IASLC should take action to expand its focus from precision treatment to early detection and prevention.Our goal is to reduce lung cancer mortality globally.