Nonaka Makoto, Kadokura Mitsutaka, Yamamoto Shigeru, Kataoka Daisuke, Kunimura Toshiaki, Kushima Miki, Horichi Naoya, Takaba Toshihiro
First Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
Am J Clin Oncol. 2003 Oct;26(5):499-503. doi: 10.1097/01.coc.0000037739.92442.52.
Tumors with a maximum dimension of 3 cm are categorized as T1, whereas those greater than 3 cm are T2 by TNM classification. Some physicians suggest that early-stage peripheral lung cancer should have a maximum tumor diameter of 2 cm and that limited surgery (segmentectomy without lymph node dissection) is acceptable for the patients. In this study, the relationship between the tumor dimension and prognosis was analyzed in 207 patients with surgically treated primary non-small-cell lung cancer (SCLC). The 5-year survival rate of those with tumors 3 cm or less and without lymph node (LN) metastases was 86%, which was significantly higher than that of those with tumors more than 3 cm and without hilar and mediastinal LN metastases (65%) (p < 0.05). However, 33% of the patients with tumors 3 cm or less had LN metastases, and the 5-year survival rate did not differ between those with tumors 3 cm or less (60%) and those with tumors more than 3 cm (54%). Twenty-eight percent of patients with tumors 2 cm or less had LN metastases, and the 5-year survival rate of the patients with tumors 2 cm or less was 62%. The 5-year survival rate of those with tumors 2 cm or less and without LN metastases was 88%. Forty-six patients with tumors 2 cm or less included 5 cases with an intrapulmonary metastasis in the same lobe (11%). In conclusion, a size of 3 cm is an appropriate boundary as the T factor. Because those with tumors 2 cm or less have a relatively high percentage of LN metastases, intraoperative frozen sections of LN should be considered for those undergoing limited surgery for primary non-SCLCs 2 cm or less. Intrapulmonary metastases also should be considered for those undergoing limited surgery even if the maximum dimension of the primary tumor is less than 2 cm.
根据TNM分类，最大直径为3 cm的肿瘤归为T1，而大于3 cm的肿瘤归为T2。一些医生认为，早期周围型肺癌的肿瘤最大直径应≤2 cm，对于此类患者，有限手术（不进行淋巴结清扫的肺段切除术）是可行的。本研究分析了207例接受手术治疗的原发性非小细胞肺癌（SCLC）患者的肿瘤大小与预后的关系。肿瘤直径≤3 cm且无淋巴结（LN）转移患者的5年生存率为86%，显著高于肿瘤直径＞3 cm且无肺门及纵隔LN转移患者的5年生存率（65%）（p<0.05）。然而，肿瘤直径≤3 cm的患者中有33%发生了LN转移，肿瘤直径≤3 cm患者（60%）与肿瘤直径＞3 cm患者（54%）的5年生存率无差异。肿瘤直径≤2 cm的患者中有28%发生了LN转移，肿瘤直径≤2 cm患者的5年生存率为62%。肿瘤直径≤2 cm且无LN转移患者的5年生存率为88%。46例肿瘤直径≤2 cm的患者中有5例在同一肺叶发生了肺内转移（11%）。总之，3 cm大小是作为T因素的合适界限。由于肿瘤直径≤2 cm的患者LN转移率相对较高，对于接受有限手术的原发性非SCLC直径≤2 cm的患者，应考虑术中进行LN冰冻切片检查。即使原发性肿瘤最大直径＜2 cm，对于接受有限手术的患者也应考虑肺内转移情况。
