{"id":2003,"date":"2020-11-16T10:55:40","date_gmt":"2020-11-16T01:55:40","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=2003"},"modified":"2020-11-16T14:04:41","modified_gmt":"2020-11-16T05:04:41","slug":"%e8%82%ba%e7%99%8c%e3%82%b9%e3%82%af%e3%83%aa%e3%83%bc%e3%83%8b%e3%83%b3%e3%82%b0%e3%81%ab%e3%82%88%e3%82%8b%e6%ad%bb%e4%ba%a1%e7%8e%87%e3%81%ae%e4%bd%8e%e4%b8%8b","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2003","title":{"rendered":"\u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306b\u3088\u308b\u6b7b\u4ea1\u7387\u306e\u4f4e\u4e0b"},"content":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002<\/p>\n

\u2015\u6587\u732e\u540d\uff0d
\nH.J. de Koning. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. NEJM. 2020 Feb 6; 382(6): 503-513.<\/p>\n

\u2015\u8981\u7d04\uff0d
\nIntroduction
\n\u80ba\u764c\u306f\u764c\u306b\u3088\u308b\u6b7b\u4ea1\u306e\u4e3b\u8981\u306a\u539f\u56e0\u3067\u3042\u308a\u3001\u8a3a\u65ad\u306e\u6642\u70b9\u3067\u7d0470%\u9032\u884c\u764c\u30015\u5e74\u751f\u5b58\u7387\u306f15%\u3068\u4f4e\u3044\u3002\u55ab\u7159\u7387\u306f\u4f4e\u4e0b\u3057\u3066\u3044\u308b\u3082\u306e\u306e\u3001\u3044\u307e\u3060\u306b\u6210\u4eba\u306e17-28%\u306f\u55ab\u7159\u8005\u3067\u3001\u30bf\u30d0\u30b3\u95a2\u9023\u75be\u60a3\u306e\u554f\u984c\u306f\u6df1\u523b\u3067\u3042\u308b\u3002
\nNLST(\u7c73\u56fd\u306e\u80ba\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u8a66\u9a13)\u3067\u306f\u3001\u80ba\u764c\u306e\u9ad8\u30ea\u30b9\u30af\u8005\u306b\u304a\u3044\u3066Xp\u3068CT\u306b\u3088\u308b\u80ba\u764c\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3092\u6bd4\u8f03\u3057\u305f\u3068\u3053\u308d\u3001CT\u7fa4\u3067\u80ba\u764c\u6b7b\u4ea1\u7387\u304c20%\u4f4e\u3044\u3053\u3068\u304c\u308f\u304b\u3063\u3066\u3044\u308b\u304c\u3001\u305d\u306e\u4ed6\u306b\u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3068\u6b7b\u4ea1\u7387\u306e\u95a2\u9023\u3092\u793a\u3059\u7814\u7a76\u306f\u306a\u3044\u3002
\n2000\u5e74\u306b\u958b\u59cb\u3055\u308c\u305fNELSON\u8a66\u9a13(\u30aa\u30e9\u30f3\u30c0\u30fb\u30d9\u30eb\u30ae\u30fc\u306e\u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u8a66\u9a13)\u306f\u3001\u9ad8\u30ea\u30b9\u30af\u8005\u309210\u5e74\u9593\u8ffd\u8de1\u3057\u305f\u4f4e\u7dda\u91cf\u30fb\u30dc\u30ea\u30e5\u30fc\u30e0\u30b9\u30ad\u30e3\u30f3CT\u306b\u3088\u308b\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u304c\u80ba\u764c\u767a\u751f\u7387\u30fb\u6b7b\u4ea1\u7387\u306a\u3069\u3092\u6e1b\u5c11\u3055\u305b\u308b\u304b\u3092\u8abf\u3079\u305f\u7814\u7a76\u3067\u3042\u308b\u3002
\nMethod
\n\u7814\u7a76\u306f\u30a8\u30e9\u30b9\u30e0\u30b9\u5927\u5b66\u533b\u7642\u30bb\u30f3\u30bf\u30fc\u3001\u30b0\u30ed\u30fc\u30cb\u30f3\u30b2\u30f3\u5927\u5b66\u533b\u7642\u30bb\u30f3\u30bf\u30fc\u304c\u884c\u3063\u3066\u304a\u308a\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306e\u53c2\u52a0\u6a5f\u95a2\u306f4\u3064\u306e\u5927\u5b66\u3084\u533b\u7642\u30bb\u30f3\u30bf\u30fc(UMCG, University Medical Center Utrecht, Spaarne Gasthuis, and University Hospital Leuven)\u3067\u3042\u308b\u3002
\n\u53c2\u52a0\u8005\u306f\u55ab\u7159\u304c15\u672cx25\u5e74\u4ee5\u4e0a\u3082\u3057\u304f\u306f10\u672cx30\u5e74\u4ee5\u4e0a\u3068\u3057\u305f\u3002
\nCurrent smoker\uff1b2\u9031\u9593\u4ee5\u5185\u306e\u55ab\u7159\u6b74\u304c\u3042\u308b\u4eba
\nFormer smoker\uff1b\u904e\u53bb10\u5e74\u4ee5\u5185\u306b\u7981\u7159\u3057\u305f\u4eba
\n\u9664\u5916\u57fa\u6e96\u306f\u4e2d\u7b49\u75c7\u301c\u91cd\u75c7\u306e\u57fa\u790e\u75be\u60a3\u304c\u3042\u308a2\u968e\u3078\u3042\u304c\u308c\u306a\u3044\u3088\u3046\u306a\u4eba\u3001\u4f53\u91cd140kg\u4ee5\u4e0a\u3001\u904e\u53bb\u306e\u814e\u764c\u30fb\u60aa\u6027\u9ed2\u8272\u816b\u30fb\u4e73\u764c\u3001\u904e\u53bb5\u5e74\u4ee5\u5185\u306e\u80ba\u764c\u306e\u8a3a\u65ad\u30fb\u6cbb\u7642\u3001\u904e\u53bb1\u5e74\u306eCT\u691c\u67fb\u3092\u53d7\u3051\u305f\u4eba\u3067\u3042\u308b\u3002
\n\u5973\u6027\u3067\u4e0a\u8a18\u306e\u57fa\u6e96\u3092\u6e80\u305f\u3059\u53c2\u52a0\u8005\u306f\u5c11\u306a\u304f\u7537\u6027\u306b\u7126\u70b9\u3092\u5f53\u3066\u308b\u7814\u7a76\u3068\u306a\u3063\u305f\u3002
\n50\u6b73\u304b\u308974\u6b73\u307e\u3067\u306e\u5408\u8a0813,195\u4eba\u306e\u7537\u6027\uff08\u4e00\u6b21\u5206\u6790\uff09\u30682594\u4eba\u306e\u5973\u6027\uff08\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u5206\u6790\uff09\u304c\u7121\u4f5c\u70ba\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u305f\u3002\u2192table1
\n2004\u5e741\u6708\u304b\u30892012\u5e7412\u6708\u307e\u3067\u306e\u9593\u3067\u30014\u56de\u306e\u4f4e\u7dda\u91cfCT\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0(\u958b\u59cb\u6642\u30011\u5e74\u76ee\u30013\u5e74\u76ee\u3001\u304a\u3088\u30735.5\u5e74\u76ee)\u3092\u53d7\u3051\u305f\u4eba\u3068\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3092\u53d7\u3051\u306a\u304b\u3063\u305f\u4eba\u3068\u3092\u6bd4\u8f03\u3057\u305f\u3002 <\/p>\n

\u8ffd\u8de1\u671f\u9593\u306f5, 7, 10-11\u5e74\u3067\u884c\u3063\u305f\u3002
\n\u80ba\u764c\u7279\u7570\u7684\u306a\u6b7b\u4ea1\u7387\u3092\u7279\u5b9a\u3059\u308b\u305f\u3081\u306b\u3001\u6b7b\u56e0\u3092\u7279\u5b9a\u3059\u308b\u81e8\u5e8a\u5c02\u9580\u5bb6\u59d4\u54e1\u4f1a\u304c\u8a2d\u7acb\u3055\u308c\u3001\u5c02\u9580\u5bb6\u59d4\u54e1\u4f1a\u306e\u8a8d\u8a3c\u306b\u3088\u3063\u3066\u6b7b\u4ea1\u304c\u80ba\u764c\u3067\u3042\u308b\u3053\u3068\u304c\u7d50\u8ad6\u3065\u3051\u3089\u308c\u305f\u3002\u30e9\u30f3\u30c0\u30e0\u5272\u4ed8\u6642\u304b\u3089\u80ba\u764c\u306e\u8a3a\u65ad\u3001\u80ba\u764c\u306b\u3088\u308b\u6b7b\u4ea1\u3001\u305d\u306e\u4ed6\u306e\u539f\u56e0\u3088\u308b\u6b7b\u4ea1\u3092\u8a18\u9332\u3057\u305f\u3002<\/p>\n

\"JC202009\u4f50\u91ce\"<\/a><\/p>\n

Results
\n\u53c2\u52a0\u8005\u306f\u524d\u8ff0table1\uff08\u4e0b\u8a18\uff09\u3078\u3002\u7fa4\u9593\u306e\u7279\u6027\u306b\u306f\u6709\u610f\u5dee\u306a\u3057\u3002\u7537\u6027\u53c2\u52a0\u8005\u306f\u8a0813195\u4eba\u3067\u30016538\u4eba\u306e\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u30686612\u4eba\u306e\u5bfe\u7167\u7fa4\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u3066\u3044\u308b\u3002
\nCT\u306e\u5b9f\u65bd\u7387\u306f\u5e73\u574790%\u7a0b\u5ea6\u3002Indeterminate test\uff08\u4e0d\u78ba\u5b9f\u306a\u691c\u67fb\uff1f\uff09\u3067\u306f\u8ffd\u52a0\u691c\u67fb\u3092\u884c\u3044\u300155%\u306e\u7d50\u7bc0\u304c\u89e3\u6c7a\u3001\u6700\u7d42\u7684\u306b2.1%\u304c\u691c\u67fb\u967d\u6027\u3068\u306a\u3063\u305f\u3002\u547c\u5438\u5668\u79d1\u3067\u306e\u7cbe\u5bc6\u691c\u67fb\u306b\u3066\u5408\u8a08203\u4ef6\u304c\u80ba\u764c\u3068\u8a3a\u65ad\u3055\u308c\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306e\u967d\u6027\u7387\u306f43.5%\u3067\u3042\u3063\u305f\u3002
\n\"JC202009\u4f50\u91ce\uff12\"<\/a><\/p>\n

Fig.1 A\u306f\u8ffd\u8de1\u671f\u9593\u304a\u3088\u3073\u8a66\u9a13\u30b0\u30eb\u30fc\u30d7\u3054\u3068\u306e\u80ba\u304c\u3093\u306e\u7d2f\u7a4d\u767a\u751f\u7387\u3067\u3042\u308a\u300110\u5e74\u9593\u3067\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u30675.58\u4f8b\/1000\u4eba\u5e74\u3001\u5bfe\u7167\u7fa4\u30674.91\u4f8b\/1000\u4eba\u5e74\u3067\u3042\u3063\u305f\u3002
\nTable3\u3088\u308a\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u3067\u306fstage1A\/1B\u304c58.6%\u3068\u591a\u304b\u3063\u305f\u3053\u3068\u306b\u6bd4\u8f03\u3057\u3066\u3001\u5bfe\u7167\u7fa4\u3067\u306f13.5%\u3060\u3063\u305f\u3002Stage4\u306e\u80ba\u764c\u306f\u307b\u307c\u534a\u6570\u306e\u53c2\u52a0\u8005\u3067\u8a3a\u65ad\u3055\u308c\u3066\u3044\u308b\u304c\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3067\u691c\u51fa\u3055\u308c\u305f\u306e\u306f9.4%\u3067\u3042\u3063\u305f\u3002\u307b\u3068\u3093\u3069\u304c\u817a\u764c\u3060\u3063\u305f\u3002
\nFig.1B\u306f10\u5e74\u9593\u3067\u306e\u7d2f\u7a4d\u6b7b\u4ea1\u7387\u3067\u3042\u308b\u304c\u300110\u5e74\u9593\u306e\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u3067\u306e\u80ba\u764c\u306b\u3088\u308b\u6b7b\u4ea1\u306f\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u3067156\u4eba(2.50\u4eba\/1000\u4eba\u5e74)\u3001\u5bfe\u7167\u7fa4\u3067206\u4eba(3.30\u4eba\/1000\u4eba\u5e74)\u3067\u3042\u308a\u300110\u5e74\u5f8c\u306e\u80ba\u304c\u3093\u306b\u3088\u308b\u7d2f\u7a4d\u6b7b\u4ea1\u7387\u306f\u3001\u5bfe\u7167\u7fa4\u3068\u6bd4\u8f03\u3057\u3066\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u30670.76\uff0895\uff05\u4fe1\u983c\u533a\u9593[CI]\u30010.61\u301c0.94; P=0.01\uff09\u3067\u3042\u3063\u305f\u3002
\n\"JC202009\u4f50\u91ce\uff12\"<\/a><\/p>\n

\"JC202009\u4f50\u91ce\uff14\"<\/a><\/p>\n

Discussion
\n\u672c\u8a66\u9a13\u3067\u306f\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u9593\u9694\u304c\u6642\u9593\u7d4c\u904e\u3068\u3068\u3082\u306b\u4f38\u3073\u3066\u3044\u308b\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001\u9ad8\u30ea\u30b9\u30af\u55ab\u7159\u8005\u306e\u80ba\u764c\u6b7b\u4ea1\u7387\u304c\u5927\u5e45\u306b\u4f4e\u4e0b\u3059\u308b\u7d50\u679c\u3068\u306a\u3063\u305f\u3002\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306e\u53d7\u8a3a\u7387\u306f\u9ad8\u304f\u3001\u7537\u6027\u306e87.6%\u304c3\u56de\u306e\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u691c\u67fb\u3092\u53d7\u3051\u305f\u3002\u307e\u305f\u3001\u767a\u898b\u6642\u306e\u80ba\u764c\u306e\u591a\u304f\u304c\u521d\u671f\u6bb5\u968e\u3067\u3042\u3063\u305f\u305f\u3081\u3001\u5916\u79d1\u7684\u6cbb\u7642\u306a\u3069\u306e\u6839\u6cbb\u8853\u306e\u9069\u5fdc\u304c\u5897\u3048\u305f\u3002
\n \u5973\u6027\u3092\u5bfe\u8c61\u3068\u3057\u305f\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u5206\u6790\u3067\u3082CT\u306b\u3088\u308b\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306f\u80ba\u764c\u6b7b\u4ea1\u7387\u306b\u5bfe\u3057\u3066\u826f\u597d\u306a\u7d50\u679c\u304c\u5f97\u3089\u308c\u305f\u3002
\n \u5927\u91cf\u306e\u30b5\u30f3\u30d7\u30eb\u30b5\u30a4\u30ba\u3092\u8981\u3059\u308b\u305f\u3081\u3001\u5168\u6b7b\u56e0\u3067\u306f\u6709\u610f\u5dee\u3092\u793a\u3059\u3053\u3068\u306f\u3067\u304d\u306a\u304b\u3063\u305f\u304c\u3001\u80ba\u764c\u4ee5\u5916\u306e\u6b7b\u56e0\u306b\u95a2\u3057\u3066\u306f\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u7fa4\u3068\u5bfe\u7167\u7fa4\u3067\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002
\n \u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306b\u304a\u3051\u308b\u904e\u5270\u8a3a\u65ad\u306f\u8ab2\u984c\u306e\u4e00\u3064\u3067\u3042\u308b\u300210\u5e74\u306719.7%\u306e\u904e\u5270\u8a3a\u65ad\u304c\u307f\u3089\u308c\u305f\u3002
\n\u3000\u5c06\u6765\u7684\u306b\u306f\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306e\u9069\u5fdc\u306b\u306a\u308b\u9ad8\u30ea\u30b9\u30af\u60a3\u8005\u306e\u9078\u629e\u304c\u3088\u308a\u6d17\u7df4\u3055\u308c\u308b\u3053\u3068\u3067\u3001CT\u306b\u3088\u308b\u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306e\u30e1\u30ea\u30c3\u30c8\u304c\u5897\u3059\u3067\u3042\u308d\u3046\u3002<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112020\u5e749\u670823\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002 \u2015\u6587\u732e\u540d\uff0d H.J. de Koning. Reduced Lung-Cancer … \u7d9a\u304d\u3092\u8aad\u3080 \u80ba\u764c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306b\u3088\u308b\u6b7b\u4ea1\u7387\u306e\u4f4e\u4e0b<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33,5],"tags":[],"class_list":["post-2003","post","type-post","status-publish","format-standard","hentry","category-whats-new","category-5"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2003","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2003"}],"version-history":[{"count":2,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2003\/revisions"}],"predecessor-version":[{"id":2009,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2003\/revisions\/2009"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2003"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2003"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2003"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}