JCOG0802/WJOG4607L研究:肺段切除能否成为早期肺癌的标准术式?  

JCOG0802/WJOG4607L study:Could segmentectomy be the standard surgical procedure in early-stage lung cancer?

作　　者：袁永刚 马歌[2] 叶波[3] YUAN Yonggang;MA Ge;YE Bo(Department of Thoracic Surgery,Qilu Hospital of Shandong University,Qingdao,266035,Shandong,P.R.China;Department of Respiratory Medicine,Yidu Central Hospital of Weifang,Weifang,262512,Shandong,P.R.China;Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai,200030,P.R.China)

机构地区：[1]山东大学齐鲁医院胸外科,山东青岛266035 [2]山东省潍坊市益都中心医院呼吸内科,山东潍坊262512 [3]上海市胸科医院胸外科,上海200030

出　　处：《中国胸心血管外科临床杂志》2022年第10期1254-1259,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市科学技术委员会支撑项目(19441908900)。

摘　　要：肺叶切除术是早期非小细胞肺癌的标准治疗方法,而近年来肺段切除术因其保留更多肺实质,有术后肺功能好、恢复快、创伤小等优点,在早期外周型非小细胞肺癌中逐渐推广,但此前尚缺乏规范的随机临床试验研究肺段切除术带来的生存获益。由Asamura教授领衔的日本临床肿瘤小组(Japanese Clinical Oncology Group,JCOG)对此开展了系列研究,其中最备受关注的JCOG0802/WJOG4607L研究结果自2021年第101届美国胸外科学会年会公布以来,引起业内激烈讨论。该研究于2022年4月22日在《The Lancet》杂志正式发表,研究旨在确认肺段切除术在早期外周型非小细胞肺癌(肿瘤直径≤2 cm,实性成分占比>0.5)患者总体生存率上是否具有非劣效性。结果表明,尽管局部复发率更高,但肺段切除术组5年总体生存率较肺叶切除术组高,因此作者认为对于早期周围型非小细胞肺癌患者,肺段切除应成为标准手术方式。该研究结果为肺段切除术的安全性与有效性提供了有力证据,有望推进肺段切除术在此类患者甚至扩展至更多患者中的应用,但鉴于较高的局部复发率及术后肺功能未及预期,肺段切除术成为标准术式仍有问题需要解决。本文对该研究进行解读,探讨其对临床实践的指导作用并总结其局限性。Lobectomy is the standard surgical procedure of non-small cell lung cancer(NSCLC).Based on parenchymal-sparing advantage,better postoperative lung function,rapid recovery and less invasiveness,segmentectomy has been widely used in early peripheral non-small cell carcinoma in recent years.But there was no randomized clinical trials confirming survival benefit of segmentectomy.Led by Asamura,the Japanese Clinical Oncology Group(JCOG)has conducted a series of studies on this topic.Ever since the presentation at the 101st Annual Meeting of the American Society of Thoracic Surgeons(AATS)in 2021,the results of JCOG0802/WJOG4607l have triggered massive debate.This study was aimed at determining whether segmentectomy was non-inferior to lobectomy in overall survival in patients with early peripheral NSCLC(tumor diameter≤2 cm and consolidation tumor ratio>0.5),and the results were published in The Lancet on 22 April 2022.The 5-year overall survival rate was higher in the segmentectomy group than that in the lobectomy group,despite a higher rate of local recurrence,suggesting that segmentectomy should be the standard surgical procedure for those patients.Results of this study provide high-level evidence-based medicine evidence for the safety and effectiveness of segmentectomy,and are expected to promote the application of segmentectomy in those patients or even more other patient populations.However,due to the increased local recurrence rate and unsatisfactory postoperative lung function,there are still problems to be solved to make segmentectomy a standard surgical procedure.This paper interprets this study,discusses its instructiveness in clinical practice and summarizes its limitations.

关 键 词：非小细胞肺癌 肺叶切除术 肺段切除术 临床预后 

分 类 号：R734.2[医药卫生—肿瘤]