Does the method of radiologic surveillance affect survival after resection of stage I non-small cell lung cancer?
Does the method of radiologic surveillance affect survival after resection of stage I non-small cell lung cancer?
复制标题
DOI：
10.1016/j.jtcvs.2014.07.095
复制
发表时间：
2015-01-01
影响因子：
6
通讯作者：
Meyers, Bryan F.
中科院分区：
文献类型：
--
作者：
Crabtree, Traves D.;Puri, Varun;Meyers, Bryan F.
目的：关于肺癌切除术后适当的放射学监测策略仍存在争议。我们比较了监测计算机断层扫描与胸部X线摄影的影响，在病人谁接受了切除术的I期lung cancer.Methods：一项回顾性分析，所有患者接受切除术的病理I期肺癌从2000年1月至2013年4月。切除术后，随访包括常规病史和体格检查，并由治疗医生决定进行胸部X线摄影或计算机断层扫描。识别连续肺恶性肿瘤（即在任何新的网站或新的原发性复发）和生存recorded.Results：有554可评估的患者，232接受常规术后计算机断层扫描和322接受常规胸部X线摄影。术后5年生存率在计算机断层扫描组为67.8%，胸部X线摄影组为74.8%（P = 0.603）。在接受计算机断层扫描的患者中，27%（63/232）的患者发现了连续的肺部恶性肿瘤，而接受胸部X线摄影的患者中，22%（72/322）的患者发现了连续的肺部恶性肿瘤（P = 0.19）。从手术到确诊连续恶性肿瘤的平均时间，计算机断层扫描为1.93年，胸部X线摄影为2.56年（P = 0.046）。对于计算机断层扫描组，41%（26/63）的连续恶性肿瘤接受了根治性治疗，而胸部X线摄影组为40%（29/72）（P = 0.639）。考克斯比例风险分析表明，成像方式（计算机断层扫描与胸部X线摄影）与生存率无关（P = 0.958）。结论：监测计算机断层扫描可能导致早期诊断连续恶性肿瘤与胸部X线摄影在I期肺癌，虽然没有差异的生存证明。随机试验将有助于确定术后监测策略对生存率的影响。
Objectives: Controversy persists regarding appropriate radiographic surveillance strategies after lung cancer resection. We compared the impact of surveillance computed tomography scan versus chest radiography in patients who underwent resection for stage I lung cancer.Methods: A retrospective analysis was performed of all patients undergoing resection for pathologic stage I lung cancer from January 2000 to April 2013. After resection, follow-up included routine history and physical examination in conjunction with chest radiography or computed tomography at the discretion of the treating physician. Identification of successive lung malignancy (ie, recurrence at any new site or new primary) and survival were recorded.Results: There were 554 evaluable patients, with 232 receiving routine postoperative computed tomography and 322 receiving routine chest radiography. Postoperative 5-year survival was 67.8% in the computed tomography group versus 74.8% in the chest radiography group (P = .603). Successive lung malignancy was found in 27% (63/232) of patients receiving computed tomography versus 22% (72/322) receiving chest radiography (P = .19). The mean time from surgery to diagnosis of successive malignancy was 1.93 years for computed tomography versus 2.56 years for chest radiography (P = .046). For the computed tomography group, 41% (26/63) of successive malignancies were treated with curative intent versus 40% (29/72) in the chest radiography group (P = .639). Cox proportional hazard analysis indicated imaging modality (computed tomography vs chest radiography) was not associated with survival (P = .958).Conclusions: Surveillance computed tomography may result in earlier diagnosis of successive malignancy versus chest radiography in stage I lung cancer, although no difference in survival was demonstrated. A randomized trial would help determine the impact of postoperative surveillance strategies on survival.