Lederle F A, Niewoehner D E
Department of Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota.
Arch Intern Med. 1994 Nov 14;154(21):2397-400. doi: 10.1001/archinte.154.21.2397.
Surgery is generally considered to be the treatment of choice for anatomically localized non-small-cell lung cancer, but its effectiveness remains unproven. Observational studies have been of limited value because the criteria by which patients are selected for surgery create substantial differences between patients who undergo surgery and those who do not. One small randomized trial of surgery vs radiotherapy was inconclusive, but several large trials of lung cancer screening have provided indirect evidence against a benefit from surgery. Two ongoing randomized trials, one on extensive vs limited resection and the other on the effect of surgery in more extensive disease, may provide further insight into the effectiveness of surgery in the treatment of localized non-small-cell lung cancer. Development of a large randomized trial to directly assess the effectiveness of surgery in the treatment of localized non-small-cell lung cancer has been precluded by ethical concerns, but may need to be reconsidered if indicated by the findings of the two ongoing studies.
手术通常被认为是解剖学上局限性非小细胞肺癌的首选治疗方法，但其有效性仍未得到证实。观察性研究的价值有限，因为选择手术患者的标准使得接受手术的患者与未接受手术的患者之间存在很大差异。一项关于手术与放疗的小型随机试验尚无定论，但几项肺癌筛查大型试验提供了不利于手术获益的间接证据。两项正在进行的随机试验，一项是关于广泛切除与有限切除，另一项是关于手术在更广泛疾病中的效果，可能会进一步深入了解手术在治疗局限性非小细胞肺癌中的有效性。出于伦理考虑，开展一项直接评估手术治疗局限性非小细胞肺癌有效性的大型随机试验受到了阻碍，但如果两项正在进行的研究结果表明有必要，可能需要重新考虑。
