早期非小细胞肺癌外科手术方式的争议  

Controversy over surgical modalities for early non-small cell lung cancer

作　　者：武强 孔浩 张博友 钱邦伦 卢毅 孙飞 史宏灿 WU Qiang;KONG Hao;ZHANG Boyou;QIAN Banglun;LU Yi;SUN Fei;SHI Hongcan(Department of Thoracic Surgery,The Second Xiangya Hospital of Central South University,Changsha,410011,P.R.China;Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province,Yangzhou University,Yangzhou,225009,P.R.China;Northern Jiangsu People’s Hospital,Affiliated Hospital to Yangzhou University,Yangzhou,225001,P.R.China;Clinical Medical College of Yangzhou University,Yangzhou,225009,P.R.China;Institute of Translational Medicine,Medical College,Yangzhou University,Yangzhou,225009,P.R.China)

机构地区：[1]中南大学湘雅二医院胸外科,长沙410011 [2]江苏省中西医结合老年病防治重点实验室,江苏扬州225009 [3]扬州大学附属苏北人民医院,江苏扬州225001 [4]扬州大学临床医学院,江苏扬州225009 [5]扬州大学医学院(化医学研究院),江苏扬州225009

出　　处：《中国胸心血管外科临床杂志》2022年第8期1066-1072,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81770018,82070020)。

摘　　要：肺叶切除及淋巴结清扫是非小细胞肺癌的标准术式,但随着低剂量螺旋CT的广泛使用,有更多的小结节型肺癌被检出,对于此类小结节继续行肺叶切除是否合适一直备受争议。根据大量回顾性研究以及随机对照试验如JCOG0201、JCOG0804/WJOG4507L、JCOG0802及CALGB/Alliance 140503等,对于直径≤2 cm的以磨玻璃成分为主的肺癌,尤其是肿瘤实性成分比值(consolidation tumour ratio,CTR)≤0.25的结节,亚肺叶切除(楔形切除或肺段切除)安全有效;对于直径≤2 cm以实性成分为主(CTR>0.5)的肺癌,肺段切除术在术后5年总生存率和肺功能保护方面优于肺叶切除,肺段切除或许应当成为此类结节的标准术式。对于多原发肺癌的外科治疗应坚持“主病灶优先,兼顾次要病灶”的原则,结合患者自身特点综合选择恰当的治疗方案。Lobectomy and systematic nodules resection has been the standard surgical procedure for non-small cell lung cancer(NSCLC).However,increased small-size lung cancer has been identified with the widespread implementation of low-dose computed tomography(LDCT)screening,and it is controversial whether it is proper to choose lobar resection for the pulmonary nodules.Numerous retrospective researches and randomized clinical trials,such as JCOG0201,JCOG0804/WJOG4507L,JCOG0802 and CALGB/Alliance 140503,revealed that the sublobar resection was safe and effective for NSCLC with maximum tumor diameter≤2 cm and with consolidation tumor ratio(CTR)≤0.25,and that segmentectomy was superior to lobectomy with significant differences in 5-year overall survival rate and respiratory function for patients with small-size(≤2 cm,CTR>0.5)NSCLC and should be the standard surgical procedure.It is the principle for multiple primary lung cancer that priority should be given to primary lesions with secondary lesions considered,and it is feasible to handle the multiple lung nodules based on the patients'individual characteristics.

关 键 词：非小细胞肺癌 肺叶切除 肺段切除 肺楔形切除 立体定向体部放射治疗 影像引导热消融 

分 类 号：R734.2[医药卫生—肿瘤]