Nonaka M, Kadokura M, Yamamoto S, Kataoka D, Iyano K, Kawada T, Takaba T
First Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
Kyobu Geka. 2000 Aug;53(9):759-62.
A superior outcome is observed for cases of curative resection compared with that of non-curative resection. The Japan Lung Cancer Society revised "General Rule for Clinical and Pathological Record of Lung Cancer" in 1999 and relatively non-curative resection (RNCR) of former rule was categorized as complete resection. The reason and the countermeasure of RNCR for lung cancer were analyzed. During 11 years, 242 patients with primary non-small cell lung cancer were surgically treated in Showa University Hospital. One hundred patients underwent absolutely curative resection (ACR); 64, relatively curative resection (RCR); 55, RNCR; 23, absolutely non-curative resection (ANCR). Three-year survival was 90% for patients with ACR, 48% with RCR, 21% with RNCR, and 13% with ANCR. The cases for RNCR were defined as follows: RNCR-a) incomplete mediastinal lymph node dissection (n = 29), RNCR-b) partial resection of the lung without lymph nodes dissection (n = 5), RNCR-c) N 2 b metastasis (n = 14), RNCR-d) N 3 lymph node dissection with N 3 metastasis (n = 0), RNCR-e) metastasis in other lobes of the ipsilateral thoracic cage (n = 7). RNCR-a) was selected in the poor risk patients who were diagnosed as clinical N 0 or N 1. Only one out of the 29 patients was diagnosed as pathological N 2 after surgery with hilar and mediastinal lymph node sampling. Because of the excellent preoperative staging, only RNCR-a) had three year survivors among RNCR cases and the three year survival rate was 39%. RNCR-b) was selected in the severe risk patients who were diagnosed as clinical N 0. There was no death associated with complication in RNCR-b) group. Some cases of RNCR-c) (pathological N 2 b) were clinical N 0 or N 1 and there was a limitation of the preoperative clinical staging. However, some cases of the clinical N 2 were surgically treated with chemo-radiotherapy and were resulted as RNCR-c). The concepts between curative resectability and complete resectability are different and RNCR-b), c), and e) should not include the curative resection because of the poor prognosis.
与非根治性切除相比，根治性切除的病例预后更佳。日本肺癌学会于1999年修订了《肺癌临床与病理记录总则》，将原规则中的相对非根治性切除（RNCR）归类为完全切除。分析了肺癌RNCR的原因及对策。在11年期间，昭和大学医院对242例原发性非小细胞肺癌患者进行了手术治疗。100例患者接受了绝对根治性切除（ACR）；64例接受了相对根治性切除（RCR）；55例接受了RNCR；23例接受了绝对非根治性切除（ANCR）。ACR患者的三年生存率为90%，RCR患者为48%，RNCR患者为21%，ANCR患者为13%。RNCR病例定义如下：RNCR-a）纵隔淋巴结清扫不完整（n = 29），RNCR-b）未进行淋巴结清扫的肺部分切除（n = 5），RNCR-c）N2b转移（n = 14），RNCR-d）N3淋巴结清扫伴N3转移（n = 0），RNCR-e）同侧胸廓其他叶转移（n = 7）。RNCR-a）是在诊断为临床N0或N1的高危患者中选择的。29例患者中只有1例在术后进行肺门和纵隔淋巴结采样后被诊断为病理N2。由于术前分期准确，在RNCR病例中只有RNCR-a）有三年生存者，三年生存率为39%。RNCR-b）是在诊断为临床N0的严重高危患者中选择的。RNCR-b）组无并发症相关死亡。RNCR-c）（病理N2b）的一些病例为临床N0或N1，术前临床分期存在局限性。然而，一些临床N2的病例接受了放化疗手术，结果为RNCR-c）。根治性可切除性和完全可切除性的概念不同，RNCR-b）、c）和e）由于预后较差不应包括在根治性切除范围内。
