Lung Cancer Screening Beyond Smoking-Based Eligibility: Evidence, Limits, and Lessons From China.

Whether the same benefit extends to populations with different risk profiles remains unresolved, particularly in China, where a substantial share of lung cancers arise in individuals without substantial smoking history.

同样的好处是否延伸到具有不同风险特征的人群尚不明确，特别是在中国，大量的肺癌发生在没有大量吸烟史的个体中。

This review develops three linked arguments rather than surveying the field exhaustively.

这篇综述提出了三个相互关联的论点，而不是全面地审视这个领域。

First, stage shift and risk-enrichment are necessary but not sufficient; a concurrent reduction in advanced-stage incidenceis the more reliable signal of benefit.

首先，阶段转移和风险富集是必要的，但不足以作为好处的信号；更可靠的信号是同时减少晚期阶段的发病率。

Second, risk-prediction models built on tobacco-exposed cohorts are least dependable in individuals without substantial smoking history, precisely where expanding eligibility relies on them most.

其次，基于烟草暴露人群构建的风险预测模型在没有大量吸烟史的个体中最不可靠，而恰恰是在这些个体中扩大资格依赖它们最多。

Third, judging evidentiary sufficiency requires an explicit framework that treats sufficiency as a continuum rather than a binary between a randomized trial and nothing.

第三，判断证据充分性需要一个明确的框架，将充分性视为一个连续体，而不是在随机试验和无之间进行二元选择。

Chinese programs illustrate all three at scale: LDCT can be delivered broadly and can enrich early-stage detection, yet still not establish reduced lung cancer mortality with acceptable harm.

中国的项目在大规模上展示了这三点：LDCT可以广泛提供，并且可以丰富早期检测，但仍然无法确立降低肺癌死亡率与可接受的伤害。

Stage-shift findings remain vulnerable to lead-time bias, length bias, and overdiagnosis, and recent data from China and South Korea suggest that diffusion of LDCT into populations at average risk may enlarge overdiagnosis more than net benefit.

阶段转移的发现仍然容易受到领先时间偏差、长度偏差和过度诊断的影响，最近来自中国和韩国的数据表明，将LDCT扩散到平均风险的人群中可能会增加过度诊断而不是净收益。

For populations without substantial smoking history, eligibility decisions should rest on prospective evidence of reduced advanced-stage incidencerather than stage-shift enrichment alone; expansion belongs within disciplined prospective evaluation.

对于没有显著吸烟史的人群，资格决策应依据减少晚期疾病发生率的前瞻性证据，而不仅仅是基于疾病阶段转移的富集；扩展应在有组织的前瞻性评估框架内进行。