Orrason Andri W, Sigurdsson Martin I, Baldvinsson Kristjan, Thorsteinsson Hunbogi, Jonsson Steinn, Gudbjartsson Tomas
Dept of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Dept of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
ERJ Open Res. 2017 Apr 27;3(2). doi: 10.1183/23120541.00106-2016. eCollection 2017 Apr.
We studied the rate of incidental detection of lung carcinomas and its effect on long-term survival in a nationwide cohort of patients operated for nonsmall cell lung cancer (NSCLC). All patients operated for NSCLC in Iceland during 1991-2010 were included. Demographic and clinicopathological features were compared in patients diagnosed incidentally using chest radiography or computed tomography (CT), and in those with symptomatic presentation. Multivariate analysis was used to evaluate prognostic factors. Out of 508 patients, 174 (34%) were diagnosed incidentally; in 26% of cases by chest radiography and in 8% by CT. The CT-detected tumours were significantly smaller than symptomatic tumours, diagnosed at earlier TNM (tumour, node and metastasis) stages and more often of adenocarcinoma histology. 5-year cancer-specific survival for symptomatic incidentally diagnosed patients detected by chest radiography and CT was 41%, 57% and 68%, respectively (p=0.003). After adjusting for stage, the hazard ratio (HR) for NSCLC mortality was significantly lower for incidental diagnosis by CT (HR 0.55, 95% CI 0.31‒0.98; p=0.04) compared to incidental diagnosis by chest radiography (HR 0.95, 95% CI 0.70‒1.27; p=0.71) or symptomatic diagnosis (HR 1.0). One-third of surgically treated NSCLCs were detected incidentally, with an increasing rate of incidental CT diagnosis. NSCLC patients diagnosed incidentally by CT appear to have better survival than those diagnosed incidentally by chest radiography, and particularly those who present with symptoms.
我们在一个全国性的非小细胞肺癌（NSCLC）手术患者队列中，研究了肺癌的偶然发现率及其对长期生存的影响。纳入了1991年至2010年期间在冰岛接受NSCLC手术的所有患者。比较了通过胸部X线摄影或计算机断层扫描（CT）偶然诊断的患者以及有症状表现的患者的人口统计学和临床病理特征。采用多变量分析来评估预后因素。在508例患者中，174例（34%）为偶然诊断；其中26%通过胸部X线摄影诊断，8%通过CT诊断。CT检测到的肿瘤明显小于有症状的肿瘤，在更早的TNM（肿瘤、淋巴结和转移）分期被诊断出来，且腺癌组织学类型更为常见。通过胸部X线摄影和CT偶然诊断出的有症状患者的5年癌症特异性生存率分别为41%、57%和68%（p=0.003）。在对分期进行调整后，与通过胸部X线摄影偶然诊断（风险比[HR] 0.95, 95%置信区间[CI] 0.70‒1.27；p=0.71）或有症状诊断（HR 1.0）相比，通过CT偶然诊断的NSCLC死亡风险比显著更低（HR 0.55, 95% CI 0.31‒0.98；p=0.04）。三分之一接受手术治疗的NSCLC是偶然发现的，偶然CT诊断率呈上升趋势。通过CT偶然诊断出的NSCLC患者似乎比通过胸部X线摄影偶然诊断的患者，尤其是有症状的患者，具有更好的生存率。
