Watkin S W, Hayhurst G K, Green J A
University of Liverpool, Department of Radiation Oncology, Clatterbridge Hospital, Wirral, Merseyside, UK.
Br J Cancer. 1990 Apr;61(4):590-6. doi: 10.1038/bjc.1990.132.
The purpose of this paper is to describe temporal trends in the treatment of lung cancer in the Merseyside Region of England over the years 1974-86. A detailed analysis of 9,090 cases of histologically confirmed tumours showed that age at diagnosis and histological type were important prognostic factors, with the 5 year survival of adenocarcinoma, squamous carcinoma, undifferentiated carcinoma and small cell carcinoma after treatment being 22.5%, 18.5%, 10% and 3.5% respectively. An analysis of 741 cases of small cell carcinoma given chemotherapy over the same period showed progressive improvement in 2 year survival from 2.5 to 7.5% (P less than 0.001) and this was shown to be closely associated with the increasing use of intravenous combination chemotherapy. The survival of patients who underwent surgical resection in the three periods 1974-77, 1978-81 and 1982-86 showed a continuous improvement in median survival from 13 to 30 months (P less than 0.001). Overall survival curves of all treated cases showed a significant improvement in median survival from 8 to 10 months and 5 year survival from 12.5 to 17.5% (P = 0.001). With improved staging assessment, the value of surgical resection of all histological types is emphasised, and in the case of the small cell subtype, the increasing use of combination chemotherapy would appear to have paralleled an increase in median and 2 year survival. These data support the argument that with appropriate case selection, there is a survival benefit associated with active treatment for lung cancer.
本文旨在描述1974年至1986年间英格兰默西塞德郡肺癌治疗的时间趋势。对9090例组织学确诊肿瘤病例的详细分析表明，诊断时的年龄和组织学类型是重要的预后因素，腺癌、鳞癌、未分化癌和小细胞癌治疗后的5年生存率分别为22.5%、18.5%、10%和3.5%。对同期接受化疗的741例小细胞癌病例的分析显示，2年生存率从2.5%逐步提高到7.5%（P<0.001），这表明与静脉联合化疗的使用增加密切相关。1974 - 1977年、1978 - 1981年和1982 - 1986年这三个时期接受手术切除的患者生存率显示，中位生存期从13个月持续提高到30个月（P<0.001）。所有治疗病例的总体生存曲线显示，中位生存期从8个月显著提高到10个月，5年生存率从12.5%提高到17.5%（P = 0.001）。随着分期评估的改善，强调了所有组织学类型手术切除的价值，对于小细胞亚型而言，联合化疗使用的增加似乎与中位生存期和2年生存率的提高并行。这些数据支持了这样的观点，即通过适当的病例选择，积极治疗肺癌可带来生存益处。
