诱导治疗后 IIIa 期肺癌再分期的系统评价：病理分期的预测。
A systematic review of restaging after induction therapy for stage IIIa lung cancer: prediction of pathologic stage.
机构信息
Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
出版信息
J Thorac Oncol. 2010 Mar;5(3):389-98. doi: 10.1097/JTO.0b013e3181ce3e5e.
BACKGROUND
Many clinicians use restaging after induction therapy as a way to select patients for surgery.
METHODS
A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery.
RESULTS
A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging.
CONCLUSION
The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.
背景
许多临床医生在诱导治疗后进行再分期，以此选择适合手术的患者。
方法
系统评价旨在确定诱导治疗后 III（N2）期肺癌患者再分期检查与手术病理结果的一致性。
结果
所有部位完全缓解的 CT 和正电子发射断层扫描假阴性（FN）率分别为 50%和 30%。CT 显示纵隔淋巴结受累的 FN 和假阳性率分别为 33%和 33%，而正电子发射断层扫描的 FN 和假阳性率分别为 25%和 33%。重复纵隔镜检查的 FN 率为 22%，专家操作下的食管超声和针吸检查为 14%（支气管内超声尚未提供可靠结果），而最佳全面性的原发性纵隔镜检查为 9%。这些结果不受诱导治疗类型或再分期时间的影响。
结论
除了仔细的原发性纵隔镜检查外，其他方法识别纵隔降期的能力较差。
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