Delarue N C, Starr J
Can Med Assoc J. 1967 Jan 7;96(1):8-20.
Part I of this review described the pathogenesis of lung cancer and emphasized that it was largely a preventable disease. In the present paper, attention is drawn to the prevalent but false impression that treatment of established disease is quite in-effective. In eight consecutive series of cases (over 2300 patients) the authors have seen a change in the clinical environment in which lung cancer is treated-from one of discouragement and apathy to one of outspoken encouragement and enthusiasm.Complete preoperative assessment-an evaluation of the biology of the tumour-host relationship as well as technical resectability-avoids unnecessary surgical intervention and stimulates a trend to earlier referral. This has permitted increasing use of resection with a declining mortality and a continuing improvement in overall survival. On the basis of present resectability rates (37.5%) and a 39% five-year survival rate in those who have had curative resection, it is estimated that current over-all five-year salvage should exceed 13%. This is more than a five-fold increase in survival for all patients compared to that achieved by treatment before 1952.
本综述的第一部分描述了肺癌的发病机制，并强调这在很大程度上是一种可预防的疾病。在本文中，要关注一种普遍存在但错误的观念，即对已确诊疾病的治疗相当无效。在连续八组病例（超过2300名患者）中，作者看到了肺癌治疗临床环境的变化——从沮丧和冷漠转变为直言不讳的鼓励和热情。完整的术前评估——对肿瘤与宿主关系生物学以及技术可切除性的评估——避免了不必要的手术干预，并促使出现更早转诊的趋势。这使得切除术的使用增加，死亡率下降，总体生存率持续提高。根据目前的可切除率（37.5%）以及接受根治性切除患者的39%的五年生存率，估计目前总体五年挽救率应超过13%。与1952年以前治疗所取得的生存率相比，这是所有患者生存率的五倍多的增长。
