Royal Brompton Hospital, London SW3 6NP, UK.
Respirology. 2010 Jan;15(1):44-50. doi: 10.1111/j.1440-1843.2009.01674.x.
Lung cancer remains one of the greatest medical challenges with nearly 1.5 million new cases worldwide each year and a growing tobacco epidemic in the developing world. This review summarizes briefly the current status in growing areas of clinical research. The value of screening for early disease is not yet established and trials to see if mortality can be improved as a result are in progress. Better and more accurate staging will both streamline investigation and prove cost-effective once ultrasound-guided biopsy and aspiration of mediastinal nodes become universally accepted. This, allied to the new staging classification, will improve selection of cases for surgery, intensive multimodality therapy and for adjuvant treatment postoperatively. Much still needs to be done to refine staging as within a particular stage group, the outcome shows great variation. More information is needed on the genetic make-up in some groups of tumours and not just their size; that is, more biological data on tumour growth patterns are likely to be at least as discriminating. The place of the stem cell theory of tumorigenesis is also explored in this paper. Finally, targeted therapy for advanced non-small-cell lung cancer is highlighted as a development with early promise, but still much clarification is required, before it can be considered as a universal approach in late disease.
肺癌仍然是医学上最大的挑战之一，全球每年有近 150 万例新发病例，发展中国家的烟草流行情况日益严重。本文简要总结了目前在临床研究的几个增长领域的现状。早期疾病筛查的价值尚未确定，正在进行试验以观察是否可以通过这种方法降低死亡率。更好、更准确的分期将简化检查，并在超声引导下经皮纵隔淋巴结活检和抽吸术被普遍接受后具有成本效益。这与新的分期分类相结合，将有助于选择手术、强化多模式治疗和术后辅助治疗的病例。仍有许多工作需要细化分期，因为在特定的分期组内，结果存在很大差异。需要更多关于某些肿瘤群体遗传构成的信息，而不仅仅是肿瘤的大小；也就是说，肿瘤生长模式的更多生物学数据可能至少同样具有鉴别力。本文还探讨了肿瘤发生的干细胞理论的地位。最后，强调了晚期非小细胞肺癌的靶向治疗是一个有早期希望的进展，但仍需要进一步澄清，才能将其视为晚期疾病的普遍治疗方法。
