Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer
Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer
复制标题
DOI：
10.1016/j.jtcvs.2013.11.001
复制
发表时间：
2014-05-01
影响因子：
6
通讯作者：
Altorki, Nasser
中科院分区：
文献类型：
--
作者：
Flores, Raja;Bauer, Thomas;Altorki, Nasser
目的：手术治疗是肺癌计算机断层扫描 (CT) 筛查的重要组成部分。我们报告了一项正在进行的大型筛查计划——国际早期肺癌行动计划 (I-ELCAP) 中美国站点的结果。方法：我们确定了所有接受手术切除的患者。我们比较了全国肺部筛查试验终止之前（1993-2005）和之后（2006-2011）的结果，以确定新出现的趋势。结果：在 31,646 例基线和 37,861 例年度重复 CT 筛查中，492 名患者接受了手术切除； 437 人（89%）被诊断患有肺癌； 396 名 (91%) 患有临床 I 期疾病。在 54 名（11%）非恶性疾病患者中，48 名患者接受了亚肺叶切除，6 名患者接受了肺叶切除术。所有 428 名肺癌患者（不包括 9 种典型类癌）的 15 年 Kaplan-Meier 生存率估计治愈率为 84%（95% 置信区间 [CI]，80%-88%）和 88%（95% CI， 83%-92%)对于临床I期疾病在诊断后1个月内切除。电视胸腔镜手术和亚肺叶切除术显着增加，从 10% 增加到 34%（P
Objective: Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP).Methods: We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends.Results: Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video- assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34%(P