放射监测方法是否会影响 I 期非小细胞肺癌切除术后的生存？
Does the method of radiologic surveillance affect survival after resection of stage I non-small cell lung cancer?
机构信息
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
出版信息
J Thorac Cardiovasc Surg. 2015 Jan;149(1):45-52, 53.e1-3. doi: 10.1016/j.jtcvs.2014.07.095. Epub 2014 Aug 8.
OBJECTIVES
Controversy persists regarding appropriate radiographic surveillance strategies after lung cancer resection. We compared the impact of surveillance computed tomography scan versus chest radiography in patients who underwent resection for stage I lung cancer.
METHODS
A retrospective analysis was performed of all patients undergoing resection for pathologic stage I lung cancer from January 2000 to April 2013. After resection, follow-up included routine history and physical examination in conjunction with chest radiography or computed tomography at the discretion of the treating physician. Identification of successive lung malignancy (ie, recurrence at any new site or new primary) and survival were recorded.
RESULTS
There were 554 evaluable patients, with 232 receiving routine postoperative computed tomography and 322 receiving routine chest radiography. Postoperative 5-year survival was 67.8% in the computed tomography group versus 74.8% in the chest radiography group (P = .603). Successive lung malignancy was found in 27% (63/232) of patients receiving computed tomography versus 22% (72/322) receiving chest radiography (P = .19). The mean time from surgery to diagnosis of successive malignancy was 1.93 years for computed tomography versus 2.56 years for chest radiography (P = .046). For the computed tomography group, 41% (26/63) of successive malignancies were treated with curative intent versus 40% (29/72) in the chest radiography group (P = .639). Cox proportional hazard analysis indicated imaging modality (computed tomography vs chest radiography) was not associated with survival (P = .958).
CONCLUSIONS
Surveillance computed tomography may result in earlier diagnosis of successive malignancy versus chest radiography in stage I lung cancer, although no difference in survival was demonstrated. A randomized trial would help determine the impact of postoperative surveillance strategies on survival.
目的
肺癌切除术后，对于适当的影像学监测策略仍存在争议。我们比较了在接受Ⅰ期肺癌切除的患者中，监测 CT 扫描与胸部 X 线摄影的影响。
方法
对 2000 年 1 月至 2013 年 4 月期间所有接受Ⅰ期肺癌切除术的患者进行回顾性分析。手术后，根据治疗医生的判断，随访包括常规病史和体格检查，联合进行胸部 X 线摄影或 CT 检查。记录连续的肺部恶性肿瘤（即任何新部位的复发或新原发性肿瘤）和生存情况。
结果
共有 554 例可评估患者，其中 232 例接受常规术后 CT 检查，322 例接受常规胸部 X 线摄影。CT 组术后 5 年生存率为 67.8%，X 线摄影组为 74.8%（P=0.603）。CT 组发现连续肺部恶性肿瘤的患者占 27%（63/232），X 线摄影组为 22%（72/322）（P=0.19）。从手术到连续恶性肿瘤诊断的平均时间，CT 组为 1.93 年，X 线摄影组为 2.56 年（P=0.046）。在 CT 组中，41%（26/63）的连续恶性肿瘤采用根治性治疗，X 线摄影组为 40%（29/72）（P=0.639）。Cox 比例风险分析表明，影像学方式（CT 与 X 线摄影）与生存无关（P=0.958）。
结论
与胸部 X 线摄影相比，Ⅰ期肺癌的监测 CT 可能更早诊断出连续的恶性肿瘤，但并未显示出生存率的差异。一项随机试验将有助于确定术后监测策略对生存的影响。
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