Herder G J M, Verboom P, Smit E F, van Velthoven P C M, van den Bergh J H A M, Colder C D, van Mansom I, van Mourik J C, Postmus P E, Teule G J J, Hoekstra O S
Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Thorax. 2002 Jan;57(1):11-4. doi: 10.1136/thorax.57.1.11.
A study was undertaken to investigate the clinical practice, yield, and costs of preoperative staging in patients with suspected NSCLC and to obtain baseline data for prospective studies on the cost effectiveness of (18)F-fluorodeoxyglucose positron emission tomography in the management of these patients.
A retrospective study of the medical records of all patients with suspected NSCLC was performed during a 2 year interval (1993-4) in an academic and a large community hospital.
Three hundred and ninety five patients with suspected NSCLC were identified; 58 were deemed to be medically inoperable and 337 patients proceeded to the staging process. Staging required a mean (SD) of 5.1 (1.5) diagnostic tests per patient (excluding thoracotomy) carried out over a median period of 20 days (IQR 10-31). Many of the tests (including both invasive and non-invasive) were done because previous imaging tests had suggested metastases, and in most cases the results of initial tests proved to be false positives. After clinical staging, 168 patients were considered to be resectable (stage I/II) and 144 patients underwent surgery with curative intent. At surgery 33 patients (23% of those who underwent surgery) were found to have irresectable lesions and 19 (13%) had a benign lesion. Surgery was also considered to be futile in 22 patients (15%) who developed metastases or local recurrence within 12 months following radical surgery. Hospital admission was responsible for most of the costs.
In many patients staging involved considerable effort in terms of the number of diagnostic tests, the duration of the staging period and the cost, with limited success in preventing futile surgery. Failures relate to the quality of diagnostic preparation at every level of the TNM staging system.
开展了一项研究，以调查疑似非小细胞肺癌（NSCLC）患者术前分期的临床实践、产出及成本，并获取关于（18）F - 氟脱氧葡萄糖正电子发射断层扫描在这些患者管理中的成本效益的前瞻性研究的基线数据。
在一所学术医院和一所大型社区医院对1993年至1994年这两年间所有疑似NSCLC患者的病历进行回顾性研究。
共识别出395例疑似NSCLC患者；58例被认为存在手术禁忌，337例患者进入分期流程。每位患者进行分期平均（标准差）需要5.1（1.5）次诊断检查（不包括开胸手术），中位时间为20天（四分位间距10 - 31天）。许多检查（包括有创和无创检查）是因为之前的影像学检查提示有转移而进行的，且在大多数情况下，初始检查结果被证明为假阳性。经过临床分期后，168例患者被认为可切除（Ⅰ/Ⅱ期），144例患者接受了根治性手术。手术时发现33例患者（占接受手术患者的23%）存在不可切除病变，19例（13%）为良性病变。在22例患者（15%）中，手术也被认为是徒劳的，这些患者在根治性手术后12个月内发生了转移或局部复发。住院费用占大部分成本。
对于许多患者而言，分期在诊断检查数量、分期时间及成本方面都耗费了大量精力，而在预防无效手术方面成效有限。失败与TNM分期系统各个层面的诊断准备质量有关。
