108年:內專
一69歲男性，病理切片診斷確診罹患小細胞肺癌 (SCLC, small-cell lung cancer)，PET/CT掃描結果顯示右側肺門(hilar)部位有一4 x 5公分腫塊，且同側有中等量(moderate)的肋膜積水，經肋膜積水穿刺檢查，肋膜積水細胞學證實同樣有SCLC癌細胞。下列敘述何者為真?
ASurgical therapy alone has a high curative rate for his stage of SCLC
BRadiation plays no palliative role at all in therapy for this disease
CTwenty percent of patients with SCLC are diagnosed with the same stage of disease as this patient
DThe majority of patients with SCLC of this stage respond to chemotherapy alone and go into remission with a very high 3-year survival
EThis patient has extensive-stage disease
詳細解析
本題觀念：
小細胞肺癌 (SCLC) 的臨床常用二期分法為 limited-stage (局限期) 與 extensive-stage (廣泛期)，其中有限度疾病指腫瘤局限於單側胸腔且可涵蓋於單一放射治療野者；若出現惡性胸水（M1a）、對側胸腔轉移或遠處器官轉移即屬廣泛期。此分期直接影響治療策略與預後。
選項分析
-
選項A
「Surgical therapy alone has a high curative rate for his stage of SCLC」
此病人因惡性肋膜積水已屬 M1a（廣泛期），手術並非適當治療，且廣泛期手術根本無治癒意義。若為 limited-stage 早期 T1–2 N0，可能考慮 lobectomy，但不適用於本例 (cancerresearchuk.org)。 -
選項B
「Radiation plays no palliative role at all in therapy for this disease」
廣泛期 SCLC 可使用放射
...（解析預覽）...