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Current status of lung cancer diagnosis and treatment in Shanghai
LUNG CANCER Lung Cancer 10 (1994) 333-338
Letter to the editor
Current status of lung cancer diagnosis and treatment in Shanghai M.L. Liao”*, Z.P. Yanfa, Z.Q. Ling”, Y.T. Gaob, R.N. Gaob, W. Zheng , J.J. ZhaoC, Z.X. Wangd “Shanghai Chest Hospital, bShanghai Tumor Institute, ‘Shanghai First Tuberculosis Hospital, dShanghai Tuberculosis Center, 241 Huui-hai Road, Shanghai, 2ooO30, China
. ._ _. ____. (&ceived i9 May i993; revision received I I November i993; accepted i3 &xember lYY3)
Abstract
The status of diagnosis and treatment of lung cancers discovered during 1 year in the Shanghai population are presented. A total of 940 lung cancers was detected from inhabitants of 35-64 years of age, with a male/female ratio of 1.8: 1. Pathology showed 35.7% adenocarcinema and 35.1% squamous cell carcinoma. There was a predominance of adenocarcinoma (47.6%) in females and of squamous cell carcinoma (44.6%) in males. Most (68.6%) of the lesions detected were already advanced in contrast to 14.7% of Stage I disease. The need for vigilance on the part of doctors was demonstrated by the fact that 23.3% of patients were seen by the doctor within 1 month after presenting with symptoms and 44.5% of them had their diagnosis suspected within 1 month after their first hospital visit. The treatment consisted of surgery for 33.3%, chemotherapy for 35%, traditional Chinese medicine for 20% and symptomatic management for 9.6% of patients. As only 55.8% Stage I patients were treated by surgery, the treatment protocol seemed to be improperly biased. The adequate training of health workers was shown by the fact that 79.7% of these patients were confirmed by pathology and/or cytology and most of the Stage I lesions were diagnosed outside the hospital. Key words: Lung cancer/diagnosis;
Treatment; Shanghai
* Corresponding author. 0169~5002/94/$07.00 0 1994 Elsevier Science Ireland Ltd. All rights reserved. SSDI 0169-5002(93)00319-5
334
M.L. Liao et al. /Lung
Cancer 10 (1994) 333-338
1. Introduction The incidence and mortality of lung cancer in Shanghai are the highest of all the major cities in China [lo], and the 5-year survival rate of lung cancer (all types included) is 5-7% [2,3]. The authors investigated the incidence, diagnosis and treatment of lung cancer in the years 1984- 1986 among the urban population in Shanghai to see if the diagnosis was made and treatment delivered timely and justifiably. 2. Materials and methods Case control investigations were carried out in a total of 1282 cases. These included new male lung cancer patients of 35-64 years old and new female patients of 35-69 years old detected between February 1984 and February 1985. Their case histories were summarized and coiiected and the patients foiiowed up every 6 months. The hospitals and clinics included the municipal and teaching hospitals, the district hospitals, anti-TB clinics, workers’ hospitals, and the community hospitals. The summary case histories included the patient’s name, sex, age, occupation, symptoms and the date and hospital of first visit; the date and hospital/clinic of preliminary diagnosis and the date and hospital/clinic of confirmed diagnosis; the diagnostic measures taken, the extent of lesion, the mode of therapy and the result, staging by tomography, X-ray symptoms and signs, yearly follow-up including survival and treatment, date and cause of death. Differential diagnosis was made weekly through collective reading of films by three chief physicians and two pathologists each from the Shanghai Chest Hospital, Shanghai First Tuberculosis Hospital and 9tnoinv um~ nn TTTCC rritwirr fnr Y,+“b I ,mo Center. Shanghai TlJberclJ]& L...p---p ..11 hncd .,.+.,-.. -.. v-v-...v1-u 1-1 Cancer, 1985 [4]. The final diagnosis was made on the basis of cytology and/or histology as far as possible, or on clinical criteria for the diagnosis of lung cancer in combination with symptoms and signs [5]. Some of the cytological and histological slides were sent to the NC1 of the United States and a consensus consent was established. 3. Results 3.1. Sex and type of lung cancer There were 940 cases in 1984-1985 in the age group of 35-64, with a male/female ratio of 1.8:l. Adenocarcinoma was most prevalent in females, followed by squamous cell carcinoma, while squamous cell carcinoma was prevalent in males, followed by adenocarcinoma (Table 1). 3.2. Stage of disease on diagnosis Of the 940 cases in 1 year, 916 were available for staging, most of whom were advanced. However, there were more Stage I cases (14.7%) than the 2-7% as seen in OPD of Shanghai hospitals. More Stage III and IV cases were found in females
M.L. Liao et al. /Lung Cancer IO (1994) 333-338 Table
335
1
Number
of cases (%) with type of lung cancer
Sex
Squamous
ceii
by sex
Acienocarcinoma
SCiC
Others
Totai
carcinoma Male Female
270 (44.6) 60 (18.0)
176 (29) 159 (47.6)
58 (9.6) 22 (6.6)
102 (16.8) 93 (27.8)
606 334
Total
330 (35.1)
335 (35.7)
80 (8.5)
195 (20.7)
940
Including
clinical
diagnosis
without
cytologic
or histological
evidence,
other types uncertain.
than in males (Table 2). A total of 1219 cases were available for staging and typing. Of SCLC, the majority comprised Stages III (53.9%) and IV (20.3%) compared to _ ‘0, I., 3.410 (tnree casesj of Stage I and 22.4% of Stage ii. A simiiar situation was found in adenocarcinoma, in which Stage III and IV constituted 72.5%, but the proportion of Stage I was higher (16.3%). The proportion of Stage III and IV squamous cell carcinoma (56.8%) was lower than that in the other two types. 3.3. The interval between the onset of symptoms and the first
visit and the hospital
visited
For this feature, 1247 were available for analysis of which 23.8% had their first visit within 1 month, 41.1% in l-3 months, 22% in 3-6 months, and 13.1% after 6 months. The hospitals first visited were mostly district or ‘grassroots’ hospitals, making up 3oi90/nand 41,80/nof the total, respectively. 3.4. The interval between the first visit and the preliminary diagnosis and the hospital concerned
Of 1178 cases analyzed, the prelimiary diagnosis was made within 1 month in 44.5% of the cases, within 3 months in 76.9%, and took more than 3 months in 23.1%. Ninety-four cases (8%) were diagnosed when examined for other illnesses or on mass survey. In 39.5% of the cases the preliminary diagnosis was made at district hospitals and 39.8% at ‘grassroots’ hospitals.
Table 2 Number of cases (“/) in each stage of lung cancer
on diagnosis
by sex
Sex
I
II
III
IV
Total
Male Female
103 (17.7) 32 (9.6)
I I2 (19.2) 41 (12.3)
267 (45.9) 166 (49.7)
100 (17.2) 95 (28.4)
582 334
Total
135 (14.7)
153 (16.7)
433 (47.3)
195 (21.3)
916
M.L. Liao et al. /Lung
336
Cancer iii
^^^ _^^ (iW4) .W-jj8
Table 3 Number of cases (u/o)in each stage of lung cancer and mode of therapy Therapy
1
II
III
IV
Total
Surgery Radiotherapy Chemotherapy TCM Others
114 (55.8) 4 (2.0) 30 (14.8) 39 (19.1) 17 (8.3)
74 (38.5) 5 (2.6) 64 (33.3) 41 (21.4) 8 (4.2)
203 (35.5) 8 (1.4) 214 (37.4) 102 (17.8) 45 (7.9)
15 (6.0) I (2.8) 120 (47.8) 61 (24.3) 48 (19.1)
406 (33.3) 24 (2.0) 428 (35.1) 243 (20.0) 118 (9.6)
TCM, traditional Chinese medicine.
3.5. The interval between the preliminary diagnosis and the confirmed diagnosis and the hospital concerned
According to the histories of 1276 cases, the diagnosis was confirmed within 1 month in 88.2% of the total, and 72.8% were confirmed at municipal-level hospitals. 3.6. Method of confirmation Documentation of 1118 cases showed that 607 cases (54.3%) were confirmed by pathology, 284 cases (25.4%) by cytology and 227 cases (20.3%) by clinical diagnosis. 3.7. Mode of therapy This information was available for 1219 cases. Of these 44.2% of Stage I and 61.5% of Stage II lung cancers were treated non-surgically instead of by surgery. Stage III lung cancer is usually treated by radiotherapy, while only eight cases in the present series were treated in this way and 35.5% underwent surgery (Table 3). 4. Discussion
A more characteristic and factual picture of the diagnosis and treatment of lung cancer is obtained from investigations of the newly-detected cases among the urban population than from hospital information. The current status of detection and management of lung cancer is thus brought to light and the relevant causes are analyzed, thereby providing administrative and research departments with reliable reference data with a view to improving on the quality of diagnosis and treatment of lung cancer. In the present series of new lung cancer cases in the 35- to 64-year age group detected in the course of 1 year, the incidence of adenocarcinoma was similar to that of squamous cell carcinoma (35.7% and 35.1%, respectively), which is quite different from the predominance of squamous cell carcinoma in the past. This indicates a real increase of adenocarcinoma in Shanghai. On the other hand, the low incidence of adenocarcinoma in the past might be due to the fact that the previous information regarding the type of lung cancer was obtained from hospitals and was limited, and
hf. L. Liao et al. /Lung
Cancer 10 (1994) 333-338
331
to the fact that adenocarcinoma was in the advanced stage when detected and surgery or radiotherapy was only indicated in few patients. It is well known that adenocarcinoma is not as highly correlated with smoking as squamous cell carcinoma. The present series showed predominance of adenocarcinoma among females, of whom few are smokers. Hence, it is necessary to further study the nonsmoking factors contributing to lung cancer. Moreover, the male/female ratio of 1.8:1 found in the present series, though limited to the age group of 35-64, indicates lll"lT oonPP* ;n fPmolPo QO ,.~~..~nw-l 4th thp. rcwv,rtJ rotin nf 0u r;o;nCV tfVVi~nC.r+,-. llU1.1~ L~‘IU~IIcIJ I” ‘La”6 W411bb1 111 lr11141rJ) ai) ~“uq_Jal~u VVICI, UIb Irp”, LbU IcaL,” “I 2.13:1 in Shanghai [6] In the present series, only 23.8% of the patients went to the hospital for their first visits within 1 month of the initial symptoms, and 81.7% of the first visits were to district or community hospitals. A total of 44.5% of the cases were diagnosed within 1 month after the first visit and 8% were detected on mass survey or examination on account of other illnesses, which indicates the possibility of early detection of lung cancer if routine physical screening among the high-risk population, and chest X-ray for patients seen at the hospital are carried out. The remaining 55.5% were diagnosed 1 month after the first visit. The cause of the delay was a lack of vigilance on the part of the physician who misdiagnosed the disease and failed to order specific examinations. It is satisfying to see that 88.2% of the diagnoses were confirmed within 1 month and 72.8% were confirmed at a municipal-level hospital. The above results show that in order to expedite confirmation of a diagnosis, it is important on the one hand to spread knowledge of the manifestations of lung cancer among the high-risk population and to underline the importance of early medical attention and compliance with physician’s orders. On the other hand, it is important to alert the community and district hospitals to be aware of lung cancer, to familiarize them with diagnostic techniques, and to refer the uncertain cases to a well-equipped municipal-level hospitals when indicated, in a timely manner. The treatment of lung cancer is often dependent on the stage of the disease, and surgery is the first choice for Stages I and II. However, 44.2% of Stage I and 61.5% of Stage II cases in the present series were not treated surgically, thereby missing the optimai therapy. This resuit suggests that medicai workers in Slnanghai be trained in groups in the standard diagnostic and treatment practices for lung cancer and the modes of therapy, so as to offer patients the optimal treatment in time. In the course of the present study, the authors solicited the service of experienced professionals, who made it possible for the patients to be advised or managed opportunely. As a result, the rate of Stage I lung cancer was 2.4-8 times the previous reports. Of the total 33.3% had the opportunity of surgical treatment, which is higher than the previous report where only 20% were operable. The results further suggest that a well-balanced network for clinical control of lung cancer should be organized on the basis of the existing professional force, and a working system of centralized management and regular conference be set up. The effect should be an effective m_easureof the imnrovement in the =_ _ _______. ___ .~__oualitv .~....~~~,of diagnosis P--- ~~-and ~~treatment of lung cancer. 5. References 1
Du YX. Epidemiology and etiology of lung cancer. The First Guang Zhou Symposium on Lung Cancer Study. Guang Zhou 1985; 1: 8-28.
338 2
3 4 5
6
M.L. Liao et al. /Lung
Cancer 10 (1994) 333-338
Shanghai Tuberculosis Center. The survival rate analysis of 1261 cases of lung cancer in Shanghai in 1972. Chin J Tubercul Respir Dis 1979; 2 (3): 165-166. Dai DQ et al. The survival rate analysis of I517 cases of primary lung cancer in Shanghai urban in 1976. Chin J Tubercul Respir Dis 1983; 6 (6): 332-334. Mountain CF. The new international staging system for lung cancer. Chest 1986; 89: 225s. Xu CW et al. The diagnosis criteria of lung cancer. In: Xu CW, Wu SF, Sun Y, editors. Lung cancer: primary bronchial carcinoma of the lung. Shanghai: Shanghai Science and Technical Publications, 1982; 103-104. Liao ML. The epidemic of lung cancer [invited report!. The progress on early detection and diagnosis. Proceedings of Chinese Tumor Association 2nd National Conference, 29-30 November 1985, Tianjing: Chinese Medical Association, 1986; 29-33.
Letter to the editor
Current status of lung cancer diagnosis and treatment in Shanghai M.L. Liao”*, Z.P. Yanfa, Z.Q. Ling”, Y.T. Gaob, R.N. Gaob, W. Zheng , J.J. ZhaoC, Z.X. Wangd “Shanghai Chest Hospital, bShanghai Tumor Institute, ‘Shanghai First Tuberculosis Hospital, dShanghai Tuberculosis Center, 241 Huui-hai Road, Shanghai, 2ooO30, China
. ._ _. ____. (&ceived i9 May i993; revision received I I November i993; accepted i3 &xember lYY3)
Abstract
The status of diagnosis and treatment of lung cancers discovered during 1 year in the Shanghai population are presented. A total of 940 lung cancers was detected from inhabitants of 35-64 years of age, with a male/female ratio of 1.8: 1. Pathology showed 35.7% adenocarcinema and 35.1% squamous cell carcinoma. There was a predominance of adenocarcinoma (47.6%) in females and of squamous cell carcinoma (44.6%) in males. Most (68.6%) of the lesions detected were already advanced in contrast to 14.7% of Stage I disease. The need for vigilance on the part of doctors was demonstrated by the fact that 23.3% of patients were seen by the doctor within 1 month after presenting with symptoms and 44.5% of them had their diagnosis suspected within 1 month after their first hospital visit. The treatment consisted of surgery for 33.3%, chemotherapy for 35%, traditional Chinese medicine for 20% and symptomatic management for 9.6% of patients. As only 55.8% Stage I patients were treated by surgery, the treatment protocol seemed to be improperly biased. The adequate training of health workers was shown by the fact that 79.7% of these patients were confirmed by pathology and/or cytology and most of the Stage I lesions were diagnosed outside the hospital. Key words: Lung cancer/diagnosis;
Treatment; Shanghai
* Corresponding author. 0169~5002/94/$07.00 0 1994 Elsevier Science Ireland Ltd. All rights reserved. SSDI 0169-5002(93)00319-5
334
M.L. Liao et al. /Lung
Cancer 10 (1994) 333-338
1. Introduction The incidence and mortality of lung cancer in Shanghai are the highest of all the major cities in China [lo], and the 5-year survival rate of lung cancer (all types included) is 5-7% [2,3]. The authors investigated the incidence, diagnosis and treatment of lung cancer in the years 1984- 1986 among the urban population in Shanghai to see if the diagnosis was made and treatment delivered timely and justifiably. 2. Materials and methods Case control investigations were carried out in a total of 1282 cases. These included new male lung cancer patients of 35-64 years old and new female patients of 35-69 years old detected between February 1984 and February 1985. Their case histories were summarized and coiiected and the patients foiiowed up every 6 months. The hospitals and clinics included the municipal and teaching hospitals, the district hospitals, anti-TB clinics, workers’ hospitals, and the community hospitals. The summary case histories included the patient’s name, sex, age, occupation, symptoms and the date and hospital of first visit; the date and hospital/clinic of preliminary diagnosis and the date and hospital/clinic of confirmed diagnosis; the diagnostic measures taken, the extent of lesion, the mode of therapy and the result, staging by tomography, X-ray symptoms and signs, yearly follow-up including survival and treatment, date and cause of death. Differential diagnosis was made weekly through collective reading of films by three chief physicians and two pathologists each from the Shanghai Chest Hospital, Shanghai First Tuberculosis Hospital and 9tnoinv um~ nn TTTCC rritwirr fnr Y,+“b I ,mo Center. Shanghai TlJberclJ]& L...p---p ..11 hncd .,.+.,-.. -.. v-v-...v1-u 1-1 Cancer, 1985 [4]. The final diagnosis was made on the basis of cytology and/or histology as far as possible, or on clinical criteria for the diagnosis of lung cancer in combination with symptoms and signs [5]. Some of the cytological and histological slides were sent to the NC1 of the United States and a consensus consent was established. 3. Results 3.1. Sex and type of lung cancer There were 940 cases in 1984-1985 in the age group of 35-64, with a male/female ratio of 1.8:l. Adenocarcinoma was most prevalent in females, followed by squamous cell carcinoma, while squamous cell carcinoma was prevalent in males, followed by adenocarcinoma (Table 1). 3.2. Stage of disease on diagnosis Of the 940 cases in 1 year, 916 were available for staging, most of whom were advanced. However, there were more Stage I cases (14.7%) than the 2-7% as seen in OPD of Shanghai hospitals. More Stage III and IV cases were found in females
M.L. Liao et al. /Lung Cancer IO (1994) 333-338 Table
335
1
Number
of cases (%) with type of lung cancer
Sex
Squamous
ceii
by sex
Acienocarcinoma
SCiC
Others
Totai
carcinoma Male Female
270 (44.6) 60 (18.0)
176 (29) 159 (47.6)
58 (9.6) 22 (6.6)
102 (16.8) 93 (27.8)
606 334
Total
330 (35.1)
335 (35.7)
80 (8.5)
195 (20.7)
940
Including
clinical
diagnosis
without
cytologic
or histological
evidence,
other types uncertain.
than in males (Table 2). A total of 1219 cases were available for staging and typing. Of SCLC, the majority comprised Stages III (53.9%) and IV (20.3%) compared to _ ‘0, I., 3.410 (tnree casesj of Stage I and 22.4% of Stage ii. A simiiar situation was found in adenocarcinoma, in which Stage III and IV constituted 72.5%, but the proportion of Stage I was higher (16.3%). The proportion of Stage III and IV squamous cell carcinoma (56.8%) was lower than that in the other two types. 3.3. The interval between the onset of symptoms and the first
visit and the hospital
visited
For this feature, 1247 were available for analysis of which 23.8% had their first visit within 1 month, 41.1% in l-3 months, 22% in 3-6 months, and 13.1% after 6 months. The hospitals first visited were mostly district or ‘grassroots’ hospitals, making up 3oi90/nand 41,80/nof the total, respectively. 3.4. The interval between the first visit and the preliminary diagnosis and the hospital concerned
Of 1178 cases analyzed, the prelimiary diagnosis was made within 1 month in 44.5% of the cases, within 3 months in 76.9%, and took more than 3 months in 23.1%. Ninety-four cases (8%) were diagnosed when examined for other illnesses or on mass survey. In 39.5% of the cases the preliminary diagnosis was made at district hospitals and 39.8% at ‘grassroots’ hospitals.
Table 2 Number of cases (“/) in each stage of lung cancer
on diagnosis
by sex
Sex
I
II
III
IV
Total
Male Female
103 (17.7) 32 (9.6)
I I2 (19.2) 41 (12.3)
267 (45.9) 166 (49.7)
100 (17.2) 95 (28.4)
582 334
Total
135 (14.7)
153 (16.7)
433 (47.3)
195 (21.3)
916
M.L. Liao et al. /Lung
336
Cancer iii
^^^ _^^ (iW4) .W-jj8
Table 3 Number of cases (u/o)in each stage of lung cancer and mode of therapy Therapy
1
II
III
IV
Total
Surgery Radiotherapy Chemotherapy TCM Others
114 (55.8) 4 (2.0) 30 (14.8) 39 (19.1) 17 (8.3)
74 (38.5) 5 (2.6) 64 (33.3) 41 (21.4) 8 (4.2)
203 (35.5) 8 (1.4) 214 (37.4) 102 (17.8) 45 (7.9)
15 (6.0) I (2.8) 120 (47.8) 61 (24.3) 48 (19.1)
406 (33.3) 24 (2.0) 428 (35.1) 243 (20.0) 118 (9.6)
TCM, traditional Chinese medicine.
3.5. The interval between the preliminary diagnosis and the confirmed diagnosis and the hospital concerned
According to the histories of 1276 cases, the diagnosis was confirmed within 1 month in 88.2% of the total, and 72.8% were confirmed at municipal-level hospitals. 3.6. Method of confirmation Documentation of 1118 cases showed that 607 cases (54.3%) were confirmed by pathology, 284 cases (25.4%) by cytology and 227 cases (20.3%) by clinical diagnosis. 3.7. Mode of therapy This information was available for 1219 cases. Of these 44.2% of Stage I and 61.5% of Stage II lung cancers were treated non-surgically instead of by surgery. Stage III lung cancer is usually treated by radiotherapy, while only eight cases in the present series were treated in this way and 35.5% underwent surgery (Table 3). 4. Discussion
A more characteristic and factual picture of the diagnosis and treatment of lung cancer is obtained from investigations of the newly-detected cases among the urban population than from hospital information. The current status of detection and management of lung cancer is thus brought to light and the relevant causes are analyzed, thereby providing administrative and research departments with reliable reference data with a view to improving on the quality of diagnosis and treatment of lung cancer. In the present series of new lung cancer cases in the 35- to 64-year age group detected in the course of 1 year, the incidence of adenocarcinoma was similar to that of squamous cell carcinoma (35.7% and 35.1%, respectively), which is quite different from the predominance of squamous cell carcinoma in the past. This indicates a real increase of adenocarcinoma in Shanghai. On the other hand, the low incidence of adenocarcinoma in the past might be due to the fact that the previous information regarding the type of lung cancer was obtained from hospitals and was limited, and
hf. L. Liao et al. /Lung
Cancer 10 (1994) 333-338
331
to the fact that adenocarcinoma was in the advanced stage when detected and surgery or radiotherapy was only indicated in few patients. It is well known that adenocarcinoma is not as highly correlated with smoking as squamous cell carcinoma. The present series showed predominance of adenocarcinoma among females, of whom few are smokers. Hence, it is necessary to further study the nonsmoking factors contributing to lung cancer. Moreover, the male/female ratio of 1.8:1 found in the present series, though limited to the age group of 35-64, indicates lll"lT oonPP* ;n fPmolPo QO ,.~~..~nw-l 4th thp. rcwv,rtJ rotin nf 0u r;o;nCV tfVVi~nC.r+,-. llU1.1~ L~‘IU~IIcIJ I” ‘La”6 W411bb1 111 lr11141rJ) ai) ~“uq_Jal~u VVICI, UIb Irp”, LbU IcaL,” “I 2.13:1 in Shanghai [6] In the present series, only 23.8% of the patients went to the hospital for their first visits within 1 month of the initial symptoms, and 81.7% of the first visits were to district or community hospitals. A total of 44.5% of the cases were diagnosed within 1 month after the first visit and 8% were detected on mass survey or examination on account of other illnesses, which indicates the possibility of early detection of lung cancer if routine physical screening among the high-risk population, and chest X-ray for patients seen at the hospital are carried out. The remaining 55.5% were diagnosed 1 month after the first visit. The cause of the delay was a lack of vigilance on the part of the physician who misdiagnosed the disease and failed to order specific examinations. It is satisfying to see that 88.2% of the diagnoses were confirmed within 1 month and 72.8% were confirmed at a municipal-level hospital. The above results show that in order to expedite confirmation of a diagnosis, it is important on the one hand to spread knowledge of the manifestations of lung cancer among the high-risk population and to underline the importance of early medical attention and compliance with physician’s orders. On the other hand, it is important to alert the community and district hospitals to be aware of lung cancer, to familiarize them with diagnostic techniques, and to refer the uncertain cases to a well-equipped municipal-level hospitals when indicated, in a timely manner. The treatment of lung cancer is often dependent on the stage of the disease, and surgery is the first choice for Stages I and II. However, 44.2% of Stage I and 61.5% of Stage II cases in the present series were not treated surgically, thereby missing the optimai therapy. This resuit suggests that medicai workers in Slnanghai be trained in groups in the standard diagnostic and treatment practices for lung cancer and the modes of therapy, so as to offer patients the optimal treatment in time. In the course of the present study, the authors solicited the service of experienced professionals, who made it possible for the patients to be advised or managed opportunely. As a result, the rate of Stage I lung cancer was 2.4-8 times the previous reports. Of the total 33.3% had the opportunity of surgical treatment, which is higher than the previous report where only 20% were operable. The results further suggest that a well-balanced network for clinical control of lung cancer should be organized on the basis of the existing professional force, and a working system of centralized management and regular conference be set up. The effect should be an effective m_easureof the imnrovement in the =_ _ _______. ___ .~__oualitv .~....~~~,of diagnosis P--- ~~-and ~~treatment of lung cancer. 5. References 1
Du YX. Epidemiology and etiology of lung cancer. The First Guang Zhou Symposium on Lung Cancer Study. Guang Zhou 1985; 1: 8-28.
338 2
3 4 5
6
M.L. Liao et al. /Lung
Cancer 10 (1994) 333-338
Shanghai Tuberculosis Center. The survival rate analysis of 1261 cases of lung cancer in Shanghai in 1972. Chin J Tubercul Respir Dis 1979; 2 (3): 165-166. Dai DQ et al. The survival rate analysis of I517 cases of primary lung cancer in Shanghai urban in 1976. Chin J Tubercul Respir Dis 1983; 6 (6): 332-334. Mountain CF. The new international staging system for lung cancer. Chest 1986; 89: 225s. Xu CW et al. The diagnosis criteria of lung cancer. In: Xu CW, Wu SF, Sun Y, editors. Lung cancer: primary bronchial carcinoma of the lung. Shanghai: Shanghai Science and Technical Publications, 1982; 103-104. Liao ML. The epidemic of lung cancer [invited report!. The progress on early detection and diagnosis. Proceedings of Chinese Tumor Association 2nd National Conference, 29-30 November 1985, Tianjing: Chinese Medical Association, 1986; 29-33.