IRCCS Istituto Clinico Humanitas, Milan, Italy.
Eur Respir J. 2013 Dec;42(6):1706-22. doi: 10.1183/09031936.00186212. Epub 2013 May 16.
The current paradigm is that untreated lung cancer is invariably and rapidly fatal, therefore the medical community normally dismisses the idea that a patient could live with such a disease for years without any therapy. Yet evidence from lung cancer screening research and from recent clinical series suggests that, although rarely recognised in routine practice, slow-growing lung cancers do exist and are more common than previously thought. Here, current evidence is reviewed and clinical cases are illustrated to show that slow-growing lung cancer is a real clinical entity, and the reasons why management protocols developed in the screening setting may also be useful in clinical practice are discussed. Features suggesting that a lung cancer may be slow-growing are described and appraised, areas of uncertainty are examined, modern management options for early-stage disease are evaluated and the influence that all this knowledge might have on our clinical decision-making is weighed. Further research directed at developing appropriate guidelines for these peculiar but increasingly common patients is warranted.
目前的模式是，未经治疗的肺癌总是且迅速致命，因此医学界通常认为患者在未经任何治疗的情况下多年来能够与这种疾病共存的想法是不可行的。然而，来自肺癌筛查研究和最近的临床系列的证据表明，尽管在常规实践中很少被认识到，但确实存在生长缓慢的肺癌，而且比以前认为的更为常见。在这里，回顾了当前的证据，并举例说明了临床病例，以表明生长缓慢的肺癌是一种真实的临床实体，以及为什么在筛查环境中制定的管理方案在临床实践中也可能有用的原因。描述并评估了提示肺癌可能生长缓慢的特征，检查了不确定的领域，评估了早期疾病的现代管理选择，并权衡了所有这些知识对我们临床决策的影响。有必要针对这些特殊但越来越常见的患者开展进一步的研究，以制定相应的指南。
