Epidemiological characteristics and risk factors of lung cancer in a population with incidental pulmonary nodules in China: a prospective multicenter study of 10,560 cases.

Authors

Wenhua Liang, Yongzhao Zhou, Chengping Hu, Wei Xiao, Jian Zhang, Min Li, Wei Wang, Xianwei Ye, Xiangyan Zhang, Ning Chang, Chunmei Yun, Dejun Sun, Yunhui Zhang, Zheng Qin, Wei Wang, Yong Zhang, Xin Zhang, Yi Xiang, Jieming Qu, Wei Zhang, Longhua Sun, Yang Hu, Jinfu Xu, Di Wu, Jianping Zhao, Xiaoju Zhang, Hairong Bao, Xiaoju Liu, Yubiao Guo, Zhanqing Li, Qichuan Zhang, Weiyi Zhu, Lan Yang, Xiaomin Dang, Baohui Han, Zhaohui Tong, Feng Wang, Liping Liu, Minhua Peng, Shuangxiu Wu, Liuhong Zeng, Lin Teng, Xiangcheng Qiu, Bo Wang, Jinsheng Tao, Meng Yang, Junjie Zhao, Silvia S Chen, Jianbing Fan, Weimin Li, Dan Liu, Jianxing He, Nanshan Zhong

Published in

Journal of the National Cancer Center. Volume 6. Issue 4. Pages 379-390. Epub Apr 16, 2026.

Abstract

Lung cancer incidence and mortality continue to rise in China, highlighting the need for a deeper understanding of its epidemiology and optimal screening targets.
A total of 10,560 participants with 5-30 mm pulmonary nodules incidentally detected via low-dose computed tomography (LDCT)/CT were enrolled from 23 hospitals (October 2018-May 2021) and followed for 2-3 years for evaluation of circulating tumor DNA (ctDNA) biomarkers to distinguish malignant and benign nodules. Demographic, clinical, and imaging data were collected and analyzed. Lung cancer risk factors were assessed using stepwise single and multiple-factor binary logistic regression. This study reports only the baseline epidemiological characteristics of the population and the associated risk factors of lung cancer.
A higher proportion of females (56.56%) were present across all age groups, with a median age of 53 years (45-62), younger than males (55 years [46-63], P < 0.001). While 97.1% of females and 37.8% of males were non-smokers, and 68.65% of participants had no occupational exposure, 71.10% had a history of second-hand smoke exposure. Most nodules were solitary (81.24%), sub-centimeter (78.22%), and non-solid (62.49%). Malignancy was identified in 17.33% of nodules, with 97.32% classified as early-stage lung adenocarcinoma (AJCC stage 0-I: 90.35%). The malignant rate increased with age and nodule size and was also associated with multiple nodules, ground-glass nodules (GGNs), upper lobe location, and female sex. Proportion of patients with malignant nodules was similar between non-high-risk (21.04%) and high-risk (17.92%) groups based on current Chinese screening guidelines, while proportions of benign nodules were notably high for solid nodules (37.21%) and small nodules (20.15%).
Our large-scale investigation provides updated data to guide future precise clinical management of pulmonary nodules, with a particular focus on younger females and reducing overtreatment.

PMID:
42630839
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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