Ringbaek T J, Borgeskov S, Lange P, Viskum K
Bispebjerg Hospital, lungemedicinsk afdeling P.
Ugeskr Laeger. 1998 Jan 5;160(2):170-5.
Survival of patients with lung cancer is poor in Denmark and worse than in the other Nordic countries. The study focuses on the treatment, the selection for operation, prognostic factors and the prognosis in lung cancer. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Departments of Pulmonary Medicine and Thoracic Surgery, Bispebjerg Hospital, Copenhagen. Operation was performed in 83 (33%) of 252 patients with non-small-cell lung cancer. More than 70% of the 169 non-operated patients were judged inoperable on the basis of a clinical examination and a chest x-ray. The initial estimation of operability, done by the chest physician, was able to predict 91% of the inoperable patients. Therapeutic delay (diagnosis-operation) was on average 26 days and 95% were operated within 60 days. Three-year survival for all the operated patients was 36%, while 62% were alive when they were judged radically operated. For stage I tumours, 51% were alive after three years, while all with stage IV tumours were dead. In the operated patients, lung function was positively related to survival (p = 0.013). Females had a better survival than males (p = 0.01 for operated, p = 0.02 for non-operated). Among 43 with small-cell lung cancer, 32 were treated with chemotherapy, and half of these were alive after one year. Preoperative histology in peripheral lesions is of value in preventing unnecessary operations without significant losses. Mediastinoscopy should be performed before operation. Registration of TNM stage and lung function should become standard in order to make comparison from country to country more valid.
丹麦肺癌患者的生存率较低，且比其他北欧国家更差。该研究聚焦于肺癌的治疗、手术选择、预后因素及预后情况。在1991年至1993年期间，哥本哈根比斯佩比约格医院的肺病科和胸外科对467例连续患有肺部肿瘤可疑病变的患者进行了前瞻性随访。252例非小细胞肺癌患者中有83例（33%）接受了手术。169例未手术患者中，超过70%经临床检查和胸部X光判断为无法手术。由胸科医生进行的可手术性初步评估能够预测91%的无法手术患者。治疗延迟（诊断至手术）平均为26天，95%的患者在60天内接受了手术。所有手术患者的三年生存率为36%，而被判定为根治性手术的患者中有62%存活。对于I期肿瘤，三年后51%的患者存活，而所有IV期肿瘤患者均死亡。在手术患者中，肺功能与生存率呈正相关（p = 0.013）。女性的生存率高于男性（手术患者p = 0.01，未手术患者p = 0.02）。43例小细胞肺癌患者中，32例接受了化疗，其中一半在一年后存活。外周病变的术前组织学检查对于避免不必要的手术且无重大损失具有价值。手术前应进行纵隔镜检查。TNM分期和肺功能的记录应成为标准，以便更有效地进行国家间的比较。
