Wright J L, Coppin C, Mullen B J, Pare J A, Rutherford T F, Ling H, Gerein A N, Miyagishima R T, Hogg J C
Can J Surg. 1986 May;29(3):205-8.
Recent studies have shown that the survival of patients with lung cancer is improved if the tumour is resected before it becomes larger than 3 cm in diameter and before it spreads to lymph nodes. While this suggests a positive benefit from early detection, recent mass-screening studies have claimed that the benefit obtained from this procedure is illusory because it relates to a lead-time bias. This study reports the results of surgical resection of 143 primary lung cancers. The data confirmed that the predicted 5-year survival was greatest (74%) following resection of lesions that were less than 3 cm in diameter without node involvement. Analysis showed that the age of these patients was 63 +/- 8 years, the same as in patients with larger tumours and more extensive node involvement. This suggests that tumours progress rapidly from a stage at which resection is beneficial to stages at which it is not. Although it is desirable that tests predict the presence of small tumours, the high requirements for sensitivity and specificity at current prevalence rates for lung cancer make this goal impractical.
最近的研究表明，如果在肺癌肿瘤直径大于3厘米之前且在扩散至淋巴结之前进行切除，肺癌患者的生存率会提高。虽然这表明早期检测有积极益处，但最近的大规模筛查研究称，从该程序中获得的益处是虚幻的，因为这与领先时间偏倚有关。本研究报告了143例原发性肺癌手术切除的结果。数据证实，在切除直径小于3厘米且无淋巴结受累的病变后，预测的5年生存率最高（74%）。分析表明，这些患者的年龄为63±8岁，与肿瘤较大且淋巴结受累更广泛的患者相同。这表明肿瘤从切除有益的阶段迅速发展到切除无益的阶段。虽然希望检测能够预测小肿瘤的存在，但以目前肺癌的患病率对敏感性和特异性的高要求使得这一目标不切实际。
