Ikeda Norihiko, Maeda Junichi, Yashima Koichi, Tsuboi Masahiro, Kato Harubumi, Akada Soichi, Okada Shinya
Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
Ann Thorac Surg. 2004 Sep;78(3):1011-6. doi: 10.1016/j.athoracsur.2004.03.048.
The biological behavior of small adenocarcinoma is different in each patient and these are especially enormous differences when evaluating solid tumors and nonsolid tumors.
A total of 159 adenocarcinomas 2 cm or less in diameter were studied. Several clinicopathological factors were retrospectively analyzed.
The diameter of the primary tumors was less than 1 cm in 47 patients, 1-1.5 cm in 49 patients, and 1.5-2 cm in 63 patients, respectively. Almost all patients (147) were pathologic N0 and there were 12 node-positive patients (7.5%). Lymph-node involvement was observed in 1 patient with a tumor diameter measuring less than 1 cm and in 11 patients with a tumor diameter measuring 1-2 cm. According to Noguchi' s classification, 33 patients belonged to class A or B, 71 patients belonged to class C, and 55 patients belonged to class D, E, or F. The ratio of ground-glass opacity (GGO) area in the main tumor in high resolution computed tomography was classified into two groups with a threshold of 50%. There were 44 patients with a GGO ratio of equal to or greater than 50%, none of which indicated lymph-node metastasis or tumor recurrence during follow-up (5-year survival = 100%). On the contrary among 115 patients with a GGO ratio less than 50%, lymph-node involvement was indicated in 12 patients (10.4%) and the 5-year survival rate was 83.9%.
The biological malignancy of small adenocarcinomas might be accurately evaluated by the proportion of GGO area as well as the Noguchi classification.
小腺癌在每个患者中的生物学行为各不相同，在评估实性肿瘤和非实性肿瘤时差异尤为显著。
共研究了159例直径2 cm及以下的腺癌。对多个临床病理因素进行回顾性分析。
原发肿瘤直径小于1 cm的患者有47例，1 - 1.5 cm的患者有49例，1.5 - 2 cm的患者有63例。几乎所有患者（147例）病理分期为N0，有12例淋巴结阳性患者（7.5%）。在1例肿瘤直径小于1 cm的患者和11例肿瘤直径为1 - 2 cm的患者中观察到淋巴结受累。根据野口分类，33例患者属于A或B类，71例患者属于C类，55例患者属于D、E或F类。在高分辨率计算机断层扫描中，将主肿瘤中磨玻璃密度影（GGO）面积的比例以50%为阈值分为两组。GGO比例等于或大于50%的患者有44例，随访期间均未出现淋巴结转移或肿瘤复发（5年生存率 = 100%）。相反，在GGO比例小于50%的115例患者中，12例（10.4%）出现淋巴结受累，5年生存率为83.9%。
小腺癌的生物学恶性程度可通过GGO面积比例以及野口分类进行准确评估。
