Ⅲ期可切除与潜在可切除非小细胞肺癌的诊疗进展  

Diagnosis and treatment progress of stage Ⅲ resectable/potentially resectable NSCLC

作　　者：沈莹冉 戴洁[1] 姜格宁[1] 张鹏[1] Shen Yingran;Dai Jie;Jiang Gening;Zhang Peng(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中华胸心血管外科杂志》2023年第6期379-384,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：Ⅲ期NSCLC的治疗充满了挑战,其最佳治疗策略目前尚无定论。新的治疗药物和治疗手段的出现也在不断改写Ⅲ期可切除/潜在可切除NSCLC的定义。可切除N2-Ⅲ期NSCLC淋巴结通常为散在且边缘清晰,与周围结构无粘连。新辅助治疗联合手术相比于根治性放化疗可降低局部复发率。对于N3-Ⅲ期NSCLC,目前指南不推荐手术治疗。但对于局限性N3,并对化疗有持续的反应,通过谨慎筛选,手术治疗也可一试。免疫治疗在局部晚期肺癌患者中的应用已有较多前瞻性临床试验证实了其疗效。新辅助免疫治疗可显著提高主要病理缓解率和病理完全缓解率,使潜在可切除的Ⅲ期NSCLC降期后获得手术机会,并改善远期预后。新辅助免疫治疗后的疗效评估,病理活检较CT检查更可靠。总的来说,多模式新辅助治疗取得的卓越进展将带给潜在可切除Ⅲ期NSCLC患者更多的手术机会及更好的远期预后。Treatment of stage Ⅲ NSCLC is challenging,and the best treatment strategy is still controversial.The emergence of new therapeutic agents and philosophy also continues to redefine the range of resectable/potentially resectable NSCLC.Resectable N2-stage Ⅲ lymph nodes are usually scattered with well-defined margins and no adhesions to surrounding structures.Neoadjuvant therapy followed by surgery has lower local recurrence rate compared to radical radiotherapy.According to current guidelines,surgical treatment is not recommended for N3-stage Ⅲ NSCLC.However,for regional N3 disease with continuous response to chemotherapy,after careful selection,surgery may worth a try.The efficacy of immunotherapy in locally advanced lung cancer has been confirmed in many prospective clinical trials.Neoadjuvant immunotherapy significantly improves major pathological remission rates and pathological complete remission rates,which allows these downstaging patients have the chance to receive surgery and thus improve their long-term prognosis.For efficacy assessment of neoadjuvant immunotherapy,pathological biopsy is more reliable than CT.In conclusion,the progress in multimodality neoadjuvant therapy will provide more surgical opportunities and better long-term prognosis for patients with potentially resectable stage Ⅲ NSCLC.

关 键 词：新辅助治疗 边缘清晰 病理活检 远期预后 局部复发率 联合手术 免疫治疗 NSCLC 

分 类 号：R734.2[医药卫生—肿瘤]