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肺癌CT筛查20年数据对未来的帮助

从1999年我们的第一份出版物到NELSON结果分析，筛查的证据仍在不断增加，我们同时也期待着中国的结果。每一项试验都表明CT筛查非常有效且挽救了众多生命。如果每年做一次筛查，可以挽救80%的肺癌患者，这是一个巨大的获益。

Well, the evidence is continuing to increase from our first publication in 1999 to the analyst of the nelson, and we're looking forward to the, uh, results in china. Uh, each each of those trials show that ct screening is very effective and saves many many lives. If it's done on an annual basis, it can save eighty percent of those who are diagnosed with lung cancer. That's a huge benefit.

所以我认为，现在证据已经很清晰了，筛查具有很大的好处。我认为我们也已经做了足够多的实践来证明它的好处，但是现在需要做的是阐明一些更为详细的问题，如筛查的频率、筛查多长时间、生物标记的作用。

So I think that the evidence is very clear now that there is a substantial benefit to screening. I think we've done enough trials to demonstrate the benefits, but now needs to happen and is happening is that we need to understand, uh, some of the more subtle aspects, how often we need to be screened, how long we need to be screened, the role of bio markers.

这些都是亟需解答的问题。但对于筛查是否有益这个问题，已经有很明确的肯定答案了。

Those are the type of questions now that need to be answered. But the question of whether there's a benefit and whether it's a strong benefit has significantly been answered.

美国肺癌筛查有何新进展？

不尽人意，据估计大约仅有1%-4%的人接受筛查，这取决于在美国有哪些人有资格接受筛查，相比真正应该接受筛查的人群这是一个非常有限数字。所以，仅有1%-4%的人接受了筛查，我们仍需要去推广筛查项目。筛查项目的推广与发展确实需要一些时间，即使像现在已有超过70%-80% 符合条件的人群参与的乳腺癌筛查，也是经过一定时间发展而来的。

Well, It's been quite poor. So it's estimated that some between one to four percent.

depending on which part of the US of the people have who are eligible for screening, which is already a limited number of those who really should be screened.

So only one to four percent are really opting to be screened. And we need to develop that screening programs do take some time to develop even.

screening for breast cancer, which now is I think over seventy, eighty percent of people who are eligible are screened for breast cancer.

我们需要大力推动肺癌CT筛查项目的发展。尽管我们已经有了一个斥资巨大的NELSON随机试验筛查结果的支持，但令人惊讶的是筛查接受率仍然很低。一些可能的解释包括，肺癌筛查相对而言仍比较新兴，也许接受的人群会随着时间的推移而增加。

That took a while to develop, and we need to very strongly push it further for ct screening for lung cancer.

Yes even though we had the results of a expensive large randomized trial supporting screening.

The uptake has been surprisingly low. Now some of the explanations for this might be that it's still relatively new and perhaps it will increase over time.

但另一种解释是，我认为，在于过分强调筛查的危害，甚至夸大了筛查的危害，而忽视了筛查的真正好处。我认为，以上因素可能就是美国肺癌筛查率低的原因，当然，这也是整个欧洲乃至亚洲部分地区肺癌筛查率低的原因。我认为随着信息的不断涌现，人们的接受意愿也在不断提高。

But the other explanation for that relates to, I think, in over emphasis on the harms of screening.Perhaps even an exaggeration of the harms and similarly and under emphasis on what the true benefits of screening are.

I think when you take all these factors together that probably accounts for the low uptake in the united states.and surely it's accounted for the low uptake throughout europe and and even parts of asia as well. So I think that as information continues to come out, the uptake willing improve.

NELSON结果对肺癌筛查的启示

NELSON研究结果将对欧洲产生重大影响，因为他们一直在等待这个试验结果。在未来的一年半内，一系列的举措将在欧洲实施。NELSON的研究结果将对欧洲的肺癌CT筛查产生重大影响，希望在世界范围内也是如此。是的，我想很多欧洲国家都在等待该试验的结果，有一种感觉是，他们需要了解关于自己的试验在自己的掌控下进行，这样他们就可以自己作效益-成本分析了。

The nelson results will have a big impact in europe because they've been waiting for this trial. And they now have already, uh, set out in eighteen months, sequence of events that need to happen for them to start implementing it throughout europe.

So the nelson results will have a major impact on ct screening for lung cancer in europe, hopefully around the world as well.

Yes. I think many european countries were waiting specifically for that trial to come out.

There's a feeling that they needed their own trial that was done under their own control with then and that would allow them to do their own cost analyses.

现在他们有了结果，我认为他们更有能力影响政府的政策决定。正如Henschke教授所说，不仅仅在欧洲，还有几个亚洲国家也在等待另一个试验结果。所以，现在有两个大型的、斥资巨大的、做得很好的随机试验显示了筛查的好处，我认为筛查试验的实施是不可抗拒的。

So now they have it. I think they're going to be much more in a position to influence governments to change their policies. And his doctor Henschke, she points out, It's not just in europe.

There are several asian countries as well that were waiting for another trial. So now there are too large and very expensive.

Well done randomized trials showing a benefit. So I think that it's gonna be very hard to resist implementing screening.

中国肺癌筛查试验对全球的意义

中国的试验中有生物标志物，这是第一个包含生物标志物的大型CT筛查试验，所以它应该会为生物标记的作用提供非常有用的信息。同时，中国的试验进行了每年与隔年筛查的对比，尽管NELSON给出了一些初步的结果，但中国的这项研究，将可能为随机选择每年或隔年筛查的间隔问题提供决定性的证据。

The Chinese trial has bio markers in it. And that's really the first large trial with ct that includes bio markers. So it should provide a very, very useful information as to the role of bio markers.

It also is looking at two years versus one year. And although the nelson gives some preliminary results on that, this study is where they're randomly selected into one year or two year intervals should provide conclusive evidence.

同样重要的是，这是在中国本土进行的一项试验。我们已经讨论过美国的试验并没有影响欧洲开始筛查，但如果NELSON的结果出来，美国不一定会在分析结果出来之前开始筛查。我认为由中国人自己设计并实施于本土人群的筛查试验非常重要，这样他们可以在他们自己的国家进行成本分析以确保试验是有效的。

Yeah. It's also important because It's a trial that's being done in China. And I think,you know the US trial didn't influence europe to start screening, and we've talked about that. Had the nelson come out first, I doubt the US would have started screening until the analyst iii came out.

And I think it's gonna be very important that the chinese have a trial, if they've designed, where it's done on their own people, and they can look at their own cost analysis within their own country to provide the kind of additional assurance that it's going to be effective.

Henschke教授提到的其他方面也非常重要， 我认为这些问题是具有全球性意义的。这些关于筛查间隔的结果，可能会对筛查产生巨大的影响。同样，我们都知道生物标志物最终会被纳入筛查使之更好更有效，我认为这是第一个试验它将以一种非常严谨和有意义的方式结合生物标志物市场，这将产生全球性影响。

The additionalaspects that doctor H

mentioned are very important.

These are questions that I think will have global significance though.

You know these are the additional findings of expanding the intervals. This is could have a tremendous impact on screen.

And similarly we all know that bio markers will ultimately be added to screening to make it better and more efficient.

And I think this is the first trial that's really going to be looking in a very serious and meaningful way incorporate bio markets.

And this will have global impact.

美国医生如何看待中国肺癌筛查？

首先，目前为止，他们显示了良好的登记率。当然，每个试验纳入受检者都是有挑战的，你必须根据不同的社区进行调整，我相信他们非常专业，他们也有充足的社区受检人群源，所以他们的筛查登记会很成功。

I think so far they've demonstrated very good enrollment in their in their studies.

And every trial has challenges in rolling individuals. You have to really tailor it to the different communities.

And i am sure they're very sensitive to that they have individuals from those communities.

And so I have no doubt that they will be very successful in their enrollment.

在分析方面，他们同样擅长统计、数学和计算机技术方面。所以我完全相信，它将会提供非常有用、非常有意义的结果。中国的这次试验是精心设计的。

And in terms of the analysis, they are also very good in statistical and mathematical and computer technology.

So I have full confidence that it will be it will they will provide very useful and very interesting results. Yeah. This trial was very carefully designed.

中国人在筛查方面已经有了丰富的经验，不仅对世界各地的信息资源加以利用，并为研究开发了各种筛查小程序，他们已掌握了筛查试验的精要所在。

Chinese have a large experience already in screening. They have utilized information from around the world, basically and they developed screening programs for research purposes that are smaller so that they've learned all of the intricacies of screening.

现在，针对全面的筛查试验，我认为他们已经有了足够的经验来管理所有的筛查参与者，同时他们也引进了全球顾问来协助他们。因此我认为这次试验不仅会对中国产生影响，也会对全球产生影响。

And now for their full blown trial, I think they have a large experience already to base the management of all the screening participants.

They have brought in, you know, global consultants to work with them to help.

So I think that this trial will have, as I said, impact not only in china, but really will have global impact as well.

中国筛查试验的领导团队非常出色，这是一次尤为重要的试验。

I have no doubt that it will be successful.

The leadership team that they have here within china is outstanding, and I think it should be a very important trial.

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