Okada Morihito, Nishio Wataru, Sakamoto Toshihiko, Uchino Kazuya, Yuki Tsuyoshi, Nakagawa Akio, Tsubota Noriaki
Department of Thoracic Surgery, Hyogo Medical Center for Adults, Japan.
J Thorac Cardiovasc Surg. 2005 Jan;129(1):87-93. doi: 10.1016/j.jtcvs.2004.04.030.
As a result of increasing discovery of small-sized lung cancer in clinical practice, tumor size has come to be considered an important variable affecting planning of treatment. Nevertheless, there have been no reports including large numbers of patients and focusing on tumor size, and controversy remains concerning the surgical management of small-sized tumors. Therefore, we investigated the relationships between tumor dimension and clinical and follow-up data, as well as surgical procedure in particular.
We reviewed the records of 1272 consecutive patients who underwent complete resection for non-small cell carcinoma of the lung.
Fifty patients had tumors of 10 mm or less, 273 had tumors of 11 to 20 mm, 368 had tumors of 21 to 30 mm, and 581 had tumors of greater than 30 mm in diameter. The cancer-specific 5-year survivals of patients in these 4 groups were 100%, 83.5%, 76.5%, and 57.9%, respectively. For patients with pathologic stage I disease, they were 100%, 92.6%, 84.1%, and 76.4%, respectively. Multivariate analysis demonstrated that male sex, older age, larger tumor, and advanced pathologic stage adversely affected survival. Lesser resection was performed in 167 (52%) of 323 patients with a tumor of 20 mm or less in diameter but in 156 (16%) of 949 patients with a tumor of greater than 20 mm in diameter. The percentages of lesser resection among all procedures performed were 79%, 56%, 30%, and 15% in patients with pathologic stage I disease with a tumor of 10 mm or less, 11 to 20 mm, 21 to 30 mm, and greater than 30 mm in diameter, respectively. The 5-year cancer-specific survivals of patients with pathologic stage I disease with tumors of 20 mm or less and 21 to 30 mm in diameter were 92.4% and 87.4% after lobectomy, 96.7% and 84.6% after segmentectomy, and 85.7% and 39.4% after wedge resection, respectively. On the other hand, with a tumor of greater than 30 mm in diameter, survivals were 81.3% after lobectomy, 62.9% after segmentectomy, and 0% after wedge resection, respectively.
Tumor size is an independent and significant prognostic factor and important for planning of surgical treatment. Although lobectomy should be chosen for patients with a tumor of greater than 30 mm in diameter, further investigation is required for tumors of 21 to 30 mm in diameter. Segmentectomy should, as a lesser anatomic resection, be distinguished from wedge resection and might be acceptable for patients with a tumor of 20 mm or less in diameter without nodal involvement.
由于临床实践中发现的小尺寸肺癌越来越多，肿瘤大小已被视为影响治疗方案规划的一个重要变量。然而，此前尚无包含大量患者且聚焦于肿瘤大小的报告，关于小尺寸肿瘤的外科治疗仍存在争议。因此，我们研究了肿瘤大小与临床及随访数据之间的关系，尤其关注手术方式。
我们回顾了1272例连续接受肺非小细胞癌根治性切除术患者的记录。
50例患者的肿瘤直径为10mm或更小，273例患者的肿瘤直径为11至20mm，368例患者的肿瘤直径为21至30mm，581例患者的肿瘤直径大于30mm。这4组患者的癌症特异性5年生存率分别为100%、83.5%、76.5%和57.9%。对于病理分期为I期的患者，生存率分别为100%、92.6%、84.1%和76.4%。多因素分析表明，男性、年龄较大、肿瘤较大以及病理分期较晚对生存率有不利影响。在323例直径20mm或更小的肿瘤患者中，167例（52%）进行了较小范围的切除；而在949例直径大于20mm的肿瘤患者中，156例（16%）进行了较小范围的切除。在病理分期为I期的患者中，直径10mm或更小、11至20mm、21至30mm以及大于30mm的肿瘤患者，在所有手术中进行较小范围切除的比例分别为79%、56%、30%和15%。病理分期为I期、直径20mm或更小以及21至30mm的肿瘤患者，肺叶切除术后的癌症特异性5年生存率分别为92.4%和87.4%，肺段切除术后分别为96.7%和84.6%，楔形切除术后分别为85.7%和39.4%。另一方面，对于直径大于30mm的肿瘤患者，肺叶切除术后生存率为81.3%，肺段切除术后为62.9%，楔形切除术后为0%。
肿瘤大小是一个独立且重要的预后因素，对手术治疗方案的规划很重要。虽然直径大于30mm的肿瘤患者应选择肺叶切除术，但对于直径21至30mm的肿瘤，还需要进一步研究。肺段切除术作为一种范围较小的解剖性切除，应与楔形切除术区分开来，对于直径20mm或更小且无淋巴结转移的肿瘤患者可能是可以接受的。
