Tanaka K, Kubota K, Kodama T, Nagai K, Nishiwaki Y
Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan.
Ann Thorac Surg. 1999 Sep;68(3):1039-42. doi: 10.1016/s0003-4975(99)00694-3.
In the official guidelines published recently, radiographic staging procedures were not recommended for patients who have non-small-cell lung cancer with negative clinical evaluation.
We did a retrospective analysis of 755 patients with non-small-cell lung cancer in clinical stage T1-2 N0 between 1982 and 1996. The patients all had a full series of imaging procedures, based on the staging protocol. Their medical records were reviewed with respect to how often distant metastasis was detected by these procedures and whether the patients showed any symptoms and laboratory abnormalities indicating extrathoracic metastasis.
The incidence of distant metastasis detected by the imaging procedures was 2.1% (nine of 419) in T1 N0 cases and 5.4% (18 of 335) in T2 N0 cases. Silent metastasis was found only in 0.5% (2 of 419) of the T1 N0 cases and 0.9% (3 of 335) of the T2 N0 cases. The cost of these staging procedures was approximately one million dollars.
Considering the cost and time savings, staging procedures are not warranted for patients with non-small-cell lung cancer stage T1-2 N0 with negative clinical evaluations.
在最近发布的官方指南中，对于临床评估为阴性的非小细胞肺癌患者，不建议进行影像学分期检查。
我们对1982年至1996年间755例临床分期为T1-2 N0的非小细胞肺癌患者进行了回顾性分析。根据分期方案，所有患者均接受了全套影像学检查。我们审查了他们的病历，以了解通过这些检查发现远处转移的频率，以及患者是否出现任何表明胸外转移的症状和实验室异常。
在T1 N0病例中，影像学检查发现远处转移的发生率为2.1%（419例中的9例），在T2 N0病例中为5.4%（335例中的18例）。仅在0.5%（419例中的2例）的T1 N0病例和0.9%（335例中的3例）的T2 N0病例中发现了无症状转移。这些分期检查的费用约为100万美元。
考虑到成本和时间节省，对于临床评估为阴性的非小细胞肺癌T1-2 N0期患者，分期检查没有必要。
