Wisnivesky Juan P, Henschke Claudia I, Yankelevitz David F
Divisions of General Internal Medicine and Pulmonary, Mount Sinai School of Medicine, New York, New York 10029, USA.
Am J Respir Crit Care Med. 2006 Sep 15;174(6):684-8. doi: 10.1164/rccm.200602-160OC. Epub 2006 Jun 23.
Lung cancer dissemination has been cited as a potential adverse consequence of diagnostic percutaneous transthoracic needle biopsy (PTNB) of lung nodules. Despite multiple reports in the literature of malignant spread along the needle track, the potential effect of lung cancer dissemination after PTNB on survival is unknown.
To evaluate whether diagnostic PTNB is associated with increased risk of lung cancer death.
This study included 8,607 cases of surgically resected stage I non-small cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records. Overall and lung cancer-specific survival of patients who had and did not have PTNB was compared using Kaplan-Meier curves. Stratified survival analyses and Cox regression were used to compare survival with adjustment for potential confounders.
Approximately 36% of patients underwent diagnostic PTNB. Overall and lung cancer-specific survival did not differ in patients that underwent PTNB as part of their cancer diagnostic work-up and those who did not (p = 0.57 and 0.46, respectively). In stratified and multivariate analysis, PTNB was not associated with an increased risk of death after controlling for age, race, income, access to care, comorbidities, tumor histology and size, and type of treatment received.
In this large national sample, preoperative PTNB was not associated with increased risk of death. These data suggest that PTNB can be safely used for the work-up of pulmonary nodules when there is a suspicion of lung cancer.
肺癌播散被认为是诊断性经皮肺穿刺针吸活检（PTNB）肺结节的潜在不良后果。尽管文献中有多篇报道显示恶性肿瘤沿针道播散，但PTNB后肺癌播散对生存的潜在影响尚不清楚。
评估诊断性PTNB是否与肺癌死亡风险增加相关。
本研究纳入了1991年至1999年间从监测、流行病学和最终结果（SEER）登记处确诊并与医疗保险记录相关联的8607例接受手术切除的I期非小细胞肺癌病例。使用Kaplan-Meier曲线比较接受和未接受PTNB患者的总生存率和肺癌特异性生存率。采用分层生存分析和Cox回归比较生存率，并对潜在混杂因素进行调整。
约36%的患者接受了诊断性PTNB。在作为癌症诊断检查一部分接受PTNB的患者和未接受PTNB的患者中，总生存率和肺癌特异性生存率没有差异（分别为p = 0.57和0.46）。在分层和多变量分析中，在控制了年龄、种族、收入、获得医疗服务的机会、合并症、肿瘤组织学和大小以及接受的治疗类型后，PTNB与死亡风险增加无关。
在这个全国性的大样本中，术前PTNB与死亡风险增加无关。这些数据表明，当怀疑有肺癌时，PTNB可安全用于肺结节的检查。
