Chee Karen G, Nguyen Danh V, Brown Monica, Gandara David R, Wun Ted, Lara Primo N
UC Davis Cancer Center, Sacramento, CA 95817, USA.
Arch Intern Med. 2008 Jul 28;168(14):1541-9. doi: 10.1001/archinte.168.14.1541.
The Will Rogers phenomenon occurs when newer technology allows for more sensitive detection of tumor spread, resulting in stage migration and an apparent improvement in patient survival. We investigated whether use of highly sensitive positron emission tomography (PET) scanning in non-small cell lung cancer has had this effect.
We performed a retrospective analysis involving 12,395 patients with non-small cell lung cancer in the pre-PET (1994-1998) and PET (1999-2004) periods. Interperiod differences in staging procedures, clinical variables, and patient survival were evaluated.
There was a 5.4% decline in the number of patients with stage III disease and an 8.4% increase in the number of patients with stage IV disease in the PET period, corresponding with an increase in PET use from 6.3% to 20.1% (P < .001). The PET period predicted better survival with a hazard ratio (HR) of 0.95 (95% confidence interval [CI], 0.91-0.99) (P = .02). Use of PET was independently associated with better survival in patients with stage III (HR, 0.77; 95% CI, 0.69-0.85) and stage IV (HR, 0.64; 95% CI, 0.58-0.70) disease, but not those with stage I or II disease.
These data support the notion that stage migration is responsible at least in part for an apparent improvement in survival for patients with stage III and IV non-small cell lung cancer in the PET scan era.
当新技术能够更灵敏地检测肿瘤扩散时，就会出现威尔·罗杰斯现象，这会导致分期迁移以及患者生存率的明显改善。我们调查了在非小细胞肺癌中使用高灵敏度正电子发射断层扫描（PET）是否产生了这种效果。
我们对1994 - 1998年PET前时期和1999 - 2004年PET时期的12395例非小细胞肺癌患者进行了回顾性分析。评估了分期程序、临床变量和患者生存率的时期间差异。
在PET时期，III期疾病患者数量下降了5.4%，IV期疾病患者数量增加了8.4%，这与PET的使用从6.3%增加到20.1%相对应（P < 0.001）。PET时期预测生存率更好，风险比（HR）为0.95（95%置信区间[CI]，0.91 - 0.99）（P = 0.02）。PET的使用与III期（HR，0.77；95% CI，0.69 - 0.85）和IV期（HR，0.64；95% CI，0.58 - 0.70）疾病患者的更好生存率独立相关，但与I期或II期疾病患者无关。
这些数据支持这样一种观点，即分期迁移至少部分导致了PET扫描时代III期和IV期非小细胞肺癌患者生存率的明显改善。
