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Titolo:
Investigating extrathoracic metastatic disease in patients with apparentlyoperable lung cancer
Autore:
Guyatt, GH; Bethune, DCG; Deslauriers, J; Inculet, RI; Lefcoe, MS; Winton, TL; Shamji, FM; Todd, TRJ; Walter, SD; Cook, DJ; Guyatt, GH; Buckingham, LA; Duchesne, JS; Khan, H; Troyan, SM; Lefcoe, MS; Bethune, DCG; Bugden, C; Yazer, M; Deslauriers, J; Bedard, P; Carrier, G; Ferland, S; Fournier, B; Miller, JD; Bennett, WF; McDonald, E; Torbiak, RP; Shamji, FM; Marryatt, G; Matzinger, FR; Reid, KR; Winton, TL; Darling, GE; Hendler, A; Herman, S; Johnston, MR; Jones, DP; Keresteci, M; Keshavjee, S; McKneally, MF; Pearson, FG; Pugash, R; Bruce, R; Rosgen, SM; Steinhardt, M; Todd, TRJ; Inculet, RI; Casson, AG; Lefcoe, MS; Malthaner, RA; Clifton, J; Evans, KG; Finley, RJ; Fradet, G; Muller, NL; Nelems, B; Staples, C; Guyatt, GH; Cook, DJ; Darling, GE; Inculet, RI; Johnston, MR; Winton, TL; OBrien, B; Goeree, R; Griffith, LE; Walter, SD; Casson, AG; Cook, DJ; Deslauriers, J;
Indirizzi:
McMaster Univ, Hlth Sci Ctr, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 at, Hamilton, ON L8N 3Z5, Canada Dalhousie Univ, Halifax, NS, Canada Dalhousie Univ Halifax NS CanadaDalhousie Univ, Halifax, NS, Canada Univ Laval, Quebec City, PQ, Canada Univ Laval Quebec City PQ CanadaUniv Laval, Quebec City, PQ, Canada Univ Ottawa, Ottawa, ON, Canada Univ Ottawa Ottawa ON CanadaUniv Ottawa, Ottawa, ON, Canada Univ Toronto, Toronto, ON, Canada Univ Toronto Toronto ON CanadaUniv Toronto, Toronto, ON, Canada Univ Western Ontario, London, ON, Canada Univ Western Ontario London ON Canada estern Ontario, London, ON, Canada Univ British Columbia, Vancouver, BC V5Z 1M9, Canada Univ British Columbia Vancouver BC Canada V5Z 1M9 ver, BC V5Z 1M9, Canada
Titolo Testata:
ANNALS OF THORACIC SURGERY
fascicolo: 2, volume: 71, anno: 2001,
pagine: 425 - 433
SICI:
0003-4975(200102)71:2<425:IEMDIP>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
BRONCHOGENIC-CARCINOMA; CLINICAL-EVALUATION; SYSTEM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Guyatt, GH McMaster Univ, Hlth Sci Ctr, Dept Clin Epidemiol & Biostat, Room 2C12,1200Main St W, Hamilton, ON L8N 3Z5, Canada McMaster Univ Room 2C12,1200 Main St W Hamilton ON Canada L8N 3Z5
Citazione:
G.H. Guyatt et al., "Investigating extrathoracic metastatic disease in patients with apparentlyoperable lung cancer", ANN THORAC, 71(2), 2001, pp. 425-433

Abstract

Background. The optimal approach to the investigation of possible distant metastases in patients with apparently operable non-small cell lung cancer who do not have symptoms suggesting metastatic disease is controversial. Methods. We conducted a randomized, controlled trial in thoracic surgery services at mainly academic tertiary- and secondary-care general hospitals. We recruited 634 patients with apparently operable, suspected or proven non-small cell carcinoma of the lung without findings on history, physical examination, laboratory testing, or imaging suggesting extrathoracic metastases. Patients were randomly allocated to receive either mediastinoscopy and computed tomography of the chest and then, depending on the results, immediate thoracotomy or bone scintigraphy and computed tomographic scanning of the head, liver, and adrenal glands. Results. The relative risk of thoracotomy without cure (the combination ofopen and closed thoracotomy, incomplete resection, and thoracotomy with subsequent recurrence) in the full investigation group versus the limited investigation group was 0.80 (95% confidence interval [CI], 0.56 to 1.13; p = 0.20). Forty-three patients in the full investigation group and 61 patientsin the limited investigation group underwent a thoracotomy but subsequently had recurrence (relative risk, 0.70; 95% CI, 0.47 to 1.03; p = 0.07). Patients in the full investigation group were more likely to have avoided thoracotomy because of extrathoracic metastatic disease than those in the limited investigation group (22 patients versus 10 patients, respectively; relative risk, 2.19; 95% CI, 1.04 to 4.59; p value = 0.04). The total number of negative invasive tests was six in the full investigation group and one in the limited investigation group (relative risk, 6.1; 95% CI, 0.72 to 51.0; p = 0.10) and the total number of invasive tests, 11 versus six, respectively (relative risk, 1.84; 95% CI, 0.68 to 4.98; p = 0.23). The full investigation strategy cost $823 less per patient (95% CIs 2,482 to -725). Conclusions. Full investigation for metastatic disease in patients with non-small cell lung cancer without symptoms or signs of metastatic disease may reduce the number of thoracotomies without cure. The higher the thresholdfor considering symptoms to suggest metastatic disease, the more likely itis that investigation will spare patients futile thoracotomy. (C) 2001 by The Society of Thoracic Surgeons.

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Documento generato il 05/04/20 alle ore 19:01:12