Rusch Valerie W, Tsuchiya Ryosuke, Tsuboi Masahiro, Pass Harvey I, Grunenwald Dominique, Goldstraw Peter
Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Thorac Oncol. 2006 Nov;1(9 Suppl):S27-31.
Lobectomy and mediastinal lymph node dissection is the standard surgical management of early stage non-small cell lung cancer (NSCLC) because more limited resections have been associated with a higher risk of local recurrence. Nevertheless, recent lung cancer screening studies have led to the detection of an increasing number of "very early" NSCLC (defined as less than 2 cm in size) and of good-prognosis histologic subtypes, bronchioloalveolar carcinoma (BAC), and adenocarcinoma (AC), mixed subtypes that are potentially appropriate for sublobar resection. The precise indications for sublobar resection remain unclear and are the subject of ongoing clinical trials, but it seems that very early, peripherally located, node-negative AC of a predominantly BAC pattern may be adequately treated in this manner. Multifocal AC and BAC, either synchronous or metachronous, are also effectively treated by complete resection, using limited resections whenever possible. The pneumonic form of BAC, the rarest variant of this disease spectrum, continues to have a poor prognosis despite complete resection. Very limited experience suggests that lung transplantation leads to prolonged survival in highly selected patients with this histologic subtype. To improve our management of very early AC, much more information is needed about the molecular abnormalities of AC and their relationship to clinical outcomes.
肺叶切除术和纵隔淋巴结清扫术是早期非小细胞肺癌（NSCLC）的标准外科治疗方法，因为更有限的切除术与更高的局部复发风险相关。然而，最近的肺癌筛查研究发现了越来越多的“极早期”NSCLC（定义为大小小于2 cm）以及预后良好的组织学亚型，即细支气管肺泡癌（BAC）和腺癌（AC），这些混合亚型可能适合进行肺叶下切除术。肺叶下切除术的确切指征仍不明确，是正在进行的临床试验的主题，但似乎以这种方式可以充分治疗极早期、位于周边、无淋巴结转移且主要为BAC模式的AC。多灶性AC和BAC，无论是同时性还是异时性，通过完全切除也能得到有效治疗，尽可能采用有限切除术。BAC的肺炎型是该疾病谱中最罕见的变体，尽管完全切除，其预后仍然很差。非常有限的经验表明，肺移植可使高度选择的该组织学亚型患者延长生存期。为了改善我们对极早期AC的治疗，需要更多关于AC分子异常及其与临床结果关系的信息。
