磨玻璃结节型肺癌患者的个体化全程管理策略  

Personalized treatment strategy for ground-glass opacity-featured lung cancer

作　　者：傅方求 马相宜 张扬 陈海泉 FU Fangqiu;MA Xiangyi;ZHANG Yang;CHEN Haiquan(Department of Thoracic Surgery,Cancer Center,Fudan University,Shanghai,200032,P.R.China;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai,200032,P.R.China)

机构地区：[1]复旦大学附属肿瘤医院胸外科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国胸心血管外科临床杂志》2022年第1期1-10,共10页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金重点项目(81930073);国家自然科学基金面上项目(81772466)。

摘　　要：随着胸部低剂量CT的普及,磨玻璃结节(ground-glass opacity,GGO)的检出率逐年升高。影像学表现为GGO的肺部病变病理上可能是良性病变,但持续存在的GGO多提示早期肺癌。GGO型肺癌和传统肺癌不同,常见于年轻、女性和不吸烟人群,具有惰性生长的特点,外科处理窗口期长,GGO是部分传统肺癌的早期表现。GGO型肺癌目前在筛查、病理、手术及术后随访等方面缺乏共识,本文综述了GGO型肺癌的个体化全程管理策略。GGO型肺癌的筛查应该遵循"低龄、低频"的策略。原位腺癌、微浸润腺癌、贴壁亚型和非贴壁亚型肺腺癌在影像学上均能表现为GGO。GGO型肺癌的手术治疗需遵循以下策略:避免将良性病变当恶性肿瘤治疗,避免将早期肿瘤当进展期肿瘤治疗,避免将惰性肿瘤当快速进展肿瘤治疗,可选择不影响人生轨迹和职业生涯的时机进行手术。GGO型肺癌患者术前不需行气管镜和骨扫描检查。对于部分GGO型肺腺癌,亚肺叶切除便能达到根治效果,且无需进行纵隔淋巴结清扫。术中冰冻病理检查能够指导GGO型肺癌的手术方式。鉴于GGO型肺癌具有良好的预后,这部分患者可以采取更加宽松的术后随访策略。Along with the popularity of low-dose computed tomography lung cancer screening,an increasing number of lung ground-glass opacity(GGO)lesions are detected.The pathology of GGO could be benign,but persistent GGO indicates early-stage lung cancer.Distinct from traditional lung cancer,GGO-featured lung cancer is more common in the young,nonsmokers and females.GGO-featured lung cancer represents an indolent type of malignancy with a long time to intervene.However,there is still no consensus on the screening,pathology,surgical procedure,and postoperative surveillance of GGO-featured lung cancer.Therefore,we proposed a personalized treatment strategy for GGO-featured lung cancer.The screening for GGO-featured lung cancer should be conducted at young age and low frequency.Adenocarcinoma in situ,minimally invasive adenocarcinoma,lepidic,and non-lepidic growth patterns could present as GGO.The following issues should be taken into consideration while determining the treatment of GGO-featured lung cancer:avoiding treating benign disease as malignancies,avoiding treating early-stage disease as advanced-stage disease,avoiding treating indolent malignancy as aggressive malignancy,and choosing appropriate timing to receive surgery without affecting life tracks and career developments.Bronchoscope and bone scan are not necessary for preoperative examinations of GGO-featured lung adenocarcinoma.For selected patients,sublobar resection without mediastinal lymph node dissection might be sufficient.Intraoperative frozen section is an effective method to guide resection strategy.Given the excellent survival of GGO-featured lung cancer,a less intensive postoperative surveillance strategy may be sufficient.

关 键 词：磨玻璃结节 病理 预后 手术切除 筛查 

分 类 号：R734.2[医药卫生—肿瘤]