南非西开普省原发性肺癌的分期与可切除性

Staging and operability of primary lung cancer in Western Cape Province, South Africa.

作者信息

Parker M A, Moolla M S, Paris G E, Koegelenberg C F N

机构信息

Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

Division of Radiation Oncology, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

出版信息

Afr J Thorac Crit Care Med. 2022 May 5;28(1). doi: 10.7196/AJTCCM.2022.v28i1.151. eCollection 2022.

DOI:10.7196/AJTCCM.2022.v28i1.151

PMID:35814169

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9250306/

Abstract

BACKGROUND

Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation.

OBJECTIVES

To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital.

METHODS

A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital's weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution.

RESULTS

Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA.

CONCLUSION

There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

摘要

背景

肺癌是全球及南非癌症相关死亡的主要原因。从历史上看，大多数被诊断为肺癌的患者在确诊时已无法治愈。

目的

在一个可同时进行正电子发射断层扫描 - 计算机断层扫描（PET - CT）和支气管内超声引导下经支气管针吸活检（EBUS - TBNA）的中心，采用结构化诊断方法评估肺癌的肿瘤、淋巴结、转移（TNM）分期，并将结果与该医院2009年的历史队列进行比较。

方法

采用一家大型三级医院每周多学科胸部肿瘤学会议（MDT）的登记资料进行回顾性描述性观察研究。采用结构化诊断方法进行分期。纳入2019年1月1日至12月31日期间在MDT上就诊、有原发性肺癌组织诊断及充分影像学检查（胸部CT和/或PET - CT）的所有患者。记录最终分期和组织诊断结果，并与同一机构2009年的历史队列进行比较。

结果

腺癌是最常见的亚型（38.8%；n = 116）。非小细胞肺癌患者中，不到十分之一（6.3%；n = 16/254）在确诊时患有潜在可治愈的肺癌（IA期至IIIA期），显著低于2009年队列（14.5%；n = 25/173；p = 0.007）。对患者实施最多的操作是经胸针吸活检（37.54%；n = 112），其次是传统支气管镜针吸活检或活检（20.4%；n = 61），以及EBUS - TBNA（17.1%；n = 51/299）。PET - CT检查后，30例中有19例分期上调，其中18例中有9例从潜在可切除变为不可切除。其中2例在EBUS - TBNA检查后分期下调为潜在可切除。