Nakamura H, Kawasaki N, Hagiwara M, Ogata A, Kato H
Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
Cancer. 2001 Mar 15;91(6):1142-7. doi: 10.1002/1097-0142(20010315)91:6<1142::aid-cncr1110>3.0.co;2-k.
Lung-sparing treatment recently has become a choice in the treatment of patients with early hilar lung carcinoma. To select the method of treatment, it is important to evaluate the histologic extent of the tumor using endoscopy.
A total of 46 patients who underwent surgery for an endoscopically evaluated early lung carcinoma of the tracheobronchial tree were analyzed. Initial surgery was performed in 16 patients and in 30 patients surgery was performed after preoperative laser therapy. The endoscopic findings were classified into three types: superficial, nodular, and polypoid. In the resected lung, the greatest tumor dimension, the depth of mural invasion, the presence of microscopic blood and lymph vessel invasion, and metastases to the dissected lymph nodes were examined.
The mean greatest tumor dimensions were 14.6 +/- 7.3 mm (mean +/- standard deviation) in the nodular group, 23.3 +/- 12.8 mm in the superficial group, and 19.0 +/- 9.2 mm in the polypoid group. The greatest tumor dimension in the superficial group was significantly larger than that in the nodular group (P < 0.01). Preoperative endoscopic diagnosis of early hilar lung carcinoma was correct histologically in 34 of 46 cases (74.0%). Hilar lymph node metastases (N1), extrabronchial invasion, and extension to the peripheral bronchus were recognized in 12 cases. Complete disappearance of the tumor due to preoperative laser therapy was confirmed in eight patients. Lymph node metastasis was not found when the greatest tumor dimension measured < 8 mm. The overall absolute 5-year survival rate was 76.0% for all patients, 87.1% for the surgery alone group, and 70.0% for the surgery after preoperative laser therapy group.
Curative treatment of early hilar lung carcinoma is possible using photodynamic therapy alone when the tumor size is < or = 8 mm and the lesion does not extend to the peripheral bronchus.
肺保留治疗近来已成为早期肺门部肺癌患者治疗的一种选择。为选择治疗方法，利用内镜评估肿瘤的组织学范围很重要。
分析了46例行手术治疗的经内镜评估的气管支气管树早期肺癌患者。16例患者接受了初次手术，30例患者在术前激光治疗后接受了手术。内镜检查结果分为三种类型：浅表型、结节型和息肉样型。在切除的肺组织中，检查肿瘤最大直径、壁内浸润深度、微小血管和淋巴管浸润情况以及清扫淋巴结的转移情况。
结节型组肿瘤平均最大直径为14.6±7.3mm（均值±标准差），浅表型组为23.3±12.8mm，息肉样型组为十九.0±9.2mm。浅表型组肿瘤最大直径显著大于结节型组（P<0.01）。46例患者中34例（74.0%）术前内镜对早期肺门部肺癌的诊断在组织学上是正确的。12例患者出现肺门淋巴结转移（N1）、支气管外浸润以及外周支气管受累。8例患者术前激光治疗后肿瘤完全消失得到证实。当肿瘤最大直径<8mm时未发现淋巴结转移。所有患者总的5年绝对生存率为76.0%，单纯手术组为87.1%，术前激光治疗后手术组为70.0%。
当肿瘤大小≤8mm且病变未累及外周支气管时，单独使用光动力疗法有可能治愈早期肺门部肺癌。
