Carcinoma of the lung and metastatic disease of the central nervous system.
Carcinoma of the lung and metastatic disease of the central nervous system.
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肺癌和中枢神经系统转移性疾病。
DOI：
10.1164/ajrccm.178.10.1090
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发表时间：
2008
影响因子：
24.7
通讯作者：
Raftopoulos,Harry
中科院分区：
文献类型：
--
作者：
Austin,JohnHM;Mujoomdar,Amol;Powell,CharlesA;Pearson,GregoryDN;Raftopoulos,Harry
我们饶有兴趣地阅读了 Ost 博士及其同事的文章，其中 I 期非小细胞肺癌 (NSCLC) 手术切除后肺癌相关死亡率与肿瘤大小密切相关；对于 3 厘米或更大的肿瘤，腺癌相关的死亡率高于鳞状细胞癌 (1)。我们认为，这些结果的主要贡献可能是中枢神经系统（CNS）的转移性疾病。我们的研究小组于 2007 年报道，在 264 名各期 NSCLC 受试者的队列中，中枢神经系统转移性疾病的总体发生率为 36%，并且年龄调整后的中枢神经系统转移性疾病概率与原发肿瘤的大小相关（P，0.001）(2)。此外，原发性肺腺癌（43%）的中枢神经系统转移性疾病患病率远高于原发性鳞状细胞癌（13%）（P<5<0.003），2.0cm和6.0cm淋巴结阴性肺腺癌扩散至中枢神经系统的年龄调整概率分别为0.14和0.72（P<0.02）。这些结果似乎与 Ost 及其同事的结果非常吻合，并且都为最近提出的肺癌分期修订提供了强有力的支持 (3)。由于较大的肺腺癌特别容易转移至中枢神经系统，因此这些患者比较小肿瘤的患者可能从辅助化疗和预防性颅脑放疗中获益更多 (4)。我们建议辅助治疗的随机临床试验需要有足够的动力来解决这些亚组可能受益的问题。
We read with interest the article by Dr. Ost and colleagues, in which lung cancer–associated mortality after surgical resection for stage I non–small cell lung cancer (NSCLC) showed a strong correlation with tumor size; and for tumors 3 cm or larger, adenocarcinoma-associated mortality was greater than that of squamous cell carcinoma (1). We suggest that a major contribution to these results is likely to be metastatic disease to the central nervous system (CNS). Our group reported in 2007 for a cohort of 264 subjects with all stages of NSCLC an overall rate of 36% for CNS metastatic disease, and age-adjusted probability of CNS metastatic disease correlated with size of the primary tumor (P, 0.001)(2). Moreover, the prevalence of CNS metastatic disease was far greater for primary adenocarcinoma of the lung (43%) than for primary squamous cell carcinoma (13%)(P 5 0.003), and the age-adjusted probabilities of a 2.0-and 6.0-cm node-negative adenocarcinoma of the lung spreading to the CNS were 0.14 and 0.72, respectively (P, 0.02). These results appear to dovetail nicely with those of Ost and colleagues and both lend strong support to the recently proposed revisions for the staging of lung cancer (3). Because large adenocarcinomas of the lung especially tend to metastasize to the CNS, these patients may benefit more from adjuvant chemotherapy and prophylactic cranial irradiation than patients with smaller tumors (4). We suggest that randomized clinical trials of adjuvant therapy need to be adequately powered to address possible benefit to these subgroups.
高危非小细胞肺癌患者的预防性颅脑照射。
影响因子：
5.3
作者：
R. Arriagada;C. Le Péchoux;M. Baeza
通讯作者：
M. Baeza