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研究生(外文):Hsien-Chi Liao
論文名稱(外文):Is Routine Scanning Necessary for Detecting Extrathoracic Metastases in Patients with Non-small Cell Lung Cancer under Stage T1x?
指導教授(外文):Kuo-Piao ChungJin-Shing Chen
外文關鍵詞:non-small cell lung cancerlung cancer stagingbrain metastasis
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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.

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.

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.

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.
目 錄
表 目錄 3
摘 要 4
第一章 緒 論 6
第一節 實習單位簡介 6
第二節 研究背景及現況 7
第三節 當前準則與研究重要性 10
第四節 研究目的 13
第二章 文獻探討 15
第一節 非小細胞肺癌臨床期別與病理期別診斷之落差 15
第二節 非小細胞肺癌臨床症狀表現與轉移風險的關係 16
第三節 肺癌病人腦部轉移偵測工具的比較 17
第四節 國外大規模篩檢之回顧結果 18
第五節 其他文獻回顧整理 20
第三章 研究方法 21
第一節 研究對象 21
第二節 研究架構與研究變項 22
第三節 收案條件與排除條件 24
第四節 研究假說 25
第五節 統計分析方法 25
第四章 研究結果與討論 28
第五章 結論與建議 34
第一節 研究單位 34
第二節 結論 34
第三節 臨床及政策建議 35
參考文獻 36
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