Miller Daniel L, Rowland Charles M, Deschamps Claude, Allen Mark S, Trastek Victor F, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2002 May;73(5):1545-50; discussion 1550-1. doi: 10.1016/s0003-4975(02)03525-7.
Routine lung cancer screening does not currently exist in the United States. Computed tomography can detect small cancers and may well be the screening choice in the future. Controversy exists, however, regarding the surgical management of these small lung cancers.
The records of all patients were reviewed who underwent resection of solitary non-small cell lung cancers 1 cm or less in diameter from 1980 through 1999.
The study included 100 patients (56 men and 44 women) with a median age of 67 years (range 43 to 84 years). Lobectomy was performed in 71 patients, bilobectomy in 4, segmentectomy in 12, and wedge excision in 13. Ninety-four patients had complete mediastinal lymph node dissection. The cancer was an adenocarcinoma in 48 patients, squamous cell carcinoma in 26, bronchioloalveolar carcinoma in 19, large cell carcinoma in 4, adenosquamous cell carcinoma in 2, and undifferentiated in 1. Tumor diameter ranged from 3 to 10 mm. Seven patients had lymph node metastases (N1, 5 patients; N2, 2 patients). Postsurgical stage was IA in 92 patients, IB in 1, IIA in 5, and IIIA in 2. There were four operative deaths. Follow-up was complete in all patients and ranged from 4 to 214 months (median 43 months). Eighteen patients (18.0%) developed recurrent lung cancer. Overall and lung cancer-specific 5-year survivals were 64.1% and 85.4%, respectively. Patients who underwent lobectomy had significantly better survival and fewer recurrences than patients who had wedge excision or segmentectomy (p = 0.04).
Because recurrent cancer and lymph node metastasis can occur in patients with non-small cell lung cancers 1 cm or less in size, lobectomy with lymph node dissection is warranted when medically possible.
目前美国尚无常规肺癌筛查项目。计算机断层扫描能够检测出小癌症，很可能成为未来的筛查手段。然而，对于这些小肺癌的手术治疗仍存在争议。
回顾了1980年至1999年间所有接受直径1厘米及以下孤立性非小细胞肺癌切除术患者的记录。
该研究纳入了100例患者（56例男性和44例女性），中位年龄为67岁（范围43至84岁）。71例行肺叶切除术，4例行双叶切除术，12例行肺段切除术，13例行楔形切除术。94例患者进行了完整的纵隔淋巴结清扫。48例患者的癌症为腺癌，26例为鳞状细胞癌，19例为细支气管肺泡癌，4例为大细胞癌，2例为腺鳞癌，1例为未分化癌。肿瘤直径为3至10毫米。7例患者有淋巴结转移（N1，5例；N2，2例）。术后分期为IA期92例，IB期1例，IIA期5例，IIIA期2例。有4例手术死亡。所有患者均完成随访，随访时间为4至214个月（中位43个月）。18例患者（18.0%）发生复发性肺癌。总体5年生存率和肺癌特异性5年生存率分别为64.1%和85.4%。与接受楔形切除术或肺段切除术的患者相比，接受肺叶切除术的患者生存率显著更高，复发率更低（p = 0.04）。
由于直径1厘米及以下的非小细胞肺癌患者可能发生复发性癌症和淋巴结转移，在医学上可行时，应进行肺叶切除术并清扫淋巴结。
