常規性胸腔外掃描對於T1x非小細胞肺癌患者之適切性

研究背景近年來，肺癌已被統計是國內發生率最高的癌症之一，多數病人被診斷時都已屆末期，因此造成高死亡率。雖然肺癌的整體病程預後不佳，但肺癌患者的期別的判定，往往很大程度的影響其疾病治療進程。研究目的作為一名胸腔外科醫師，篩選出初期肺癌病患，並給予手術治療是我們的主要工作之ㄧ。然而透過多年臨床實務，我們發現最初期的非小細胞肺癌病患，其實罕有遠端轉移情況，但又苦無直接證據佐證，能否在低風險下省略多項掃描。研究方法利用臺大醫院肺癌登記庫為樣本，於病歷系統、影像系統、癌症管理系統分析統整2005至2015年間，所有非小細胞肺癌個案之相關訊息，建立起所需之研究資料庫。資料庫建置完畢後，再依照腫瘤大小及癌症期別分類，挑選出腫瘤直徑小於三公分以下之個案，分析其腦部轉移機率、骨骼轉移機率、以及其他遠端轉移之可能性。利用風險比、上升趨勢線等，藉以探討現行之常規性全身掃描是否有必要，和該疾病最為相關之風險因子為何。研究結果對於一公分以下之非小細胞肺癌，幾乎無腦部及骨骼轉移機率，故無須進行腦部斷層及骨骼掃描。但超過一公分以上者風險快速增加，有掃描之必要。預期貢獻本研究之預期貢獻有以下三點： 1.回應臨床端之需求：在何種條件下，非小細胞肺癌之病患，可以免除常規性胸腔外掃描之實行，以節省大量之金錢、時間及體力消耗。 2.針對小體積非小細胞肺癌而言，找出可能相關影響腫瘤遠端轉移之主要風險因子。 3.藉由本研究之成果，建立特定高風險族群，為日後大規模肺癌篩檢作為參考。

關鍵字

非小細胞肺癌；肺癌分期；腦部轉移

並列摘要

Abstract Background In recent years, statistics show that lung cancer is one of the cancers with higher incidence rates in Taiwan. Most patients are at terminal stage when diagnosed with lung cancer, so there is a high mortality rate. Although the overall prognosis is poor, the staging of lung cancer still has a major impact on its progression and treatment. Objectives As a thoracic surgeon, we are to screen lung cancer patients at their initial stage and to give them surgical treatment if possible. Many years of clinical work tells us that non-small cell lung cancer at initial stage rarely has distant metastasis. However, we now lack the direct evidence whether some scans are unnecessary at such low risks of metastases. Methods This study enrolled the non-small cell lung cancer cases in our lung cancer database at National Taiwan University Hospital from 2005 to 2015. Then, we analyzed the metastasis rates to brain, bone and other distant locations of these tumors with diameters less than 3 cm. By interpreting the risk ratios and the ascending trend lines, we discussed the necessity of some routinely performed whole body scans and the risk factors associated with metastases. Results For non-small cell lung cancers smaller than 1 cm, there was almost no brain or bone metastasis. Thus, there is no need for brain and bone scans. However, scans are suggested for those non-small cell lung cancers greater than 1 cm, as they have growing rates of metastases. There are 3 expected contributions of this study: 1.To answer the clinical question that in what conditions, patients of non-small cell lung cancers can neglect non-chest scanning. This will save money, time and energy expenditure. 2.To find the risk factors for distant metastases for non-small cell lung cancers with small sizes. 3.To establish a definition of high risk group for future large sample sized lung cancer screening. Key Words non-small cell lung cancer, lung cancer staging, brain metastasis.

並列關鍵字

non-small cell lung cancer ； lung cancer staging ； brain metastasis

參考文獻

1. Shimada, Y., et al., Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer. Chest, 2013. 143(6): p. 1626-34.

3. Osarogiagbon, R.U., Management of screening-detected stage I lung cancer. J Thorac Dis, 2016. 8(10): p. E1416-E1419.

4. Li, H., et al., When Should (9)(9)mTc Bone Scintigraphy Be Performed in cT1N0 Non-Small Cell Lung Cancer Patients? Medicine (Baltimore), 2015. 94(51): p. e2309.

5. Balekian, A.A., J.M. Fisher, and M.K. Gould, Brain Imaging for Staging of Patients With Clinical Stage IA Non-small Cell Lung Cancer in the National Lung Screening Trial: Adherence With Recommendations From the Choosing Wisely Campaign. Chest, 2016. 149(4): p. 943-50.

6. Metintas, M., et al., Detecting extrathoracic metastases in patients with non-small cell lung cancer: Is routine scanning necessary? Lung Cancer, 2007. 58(1): p. 59-67.

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常規性胸腔外掃描對於T1x非小細胞肺癌患者之適切性

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