Sato Nobuyuki, Kamata Satoshi, Niikawa Hiromichi, Imai Tadashi
Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan.
Kyobu Geka. 2012 Jan;65(1):17-20.
We reviewed surgical outcome for small-sized non-small-cell lung cancer. From 2004 to 2007, 109 patients with complete resected non-small-cell lung cancer of 2 cm or less in diameter were examined retrospectively. Sixty-five were male and 44 were female. Ages ranged 41~87 (median 68) years.Overall 5-year survival rate(OS) was 89%, and 5-year disease free survival rate(DFS) was 82%.Ground-glass opacity( GGO) dominant group[ GGO ratio ≥ 50% in high resolution computed tomography(CT)] and lymph node (LN) negative group were showed favorable DFS significantly. Other parameters,such as histology, tumor diameter, serum carcinoembryonic antigen (CEA) level, pleural invasion,vascular permeation, operative procedure, were showed no significant difference about DFS. All GGO dominant group patients(n=23) had no LN involvement and survived in disease free. Cases with LN involvement [n=10 (9%)] were all in solid group(GGO<50%) and their tumor diameter were over 10 mm. Sublober resections were performed in 28 cases( segmentectomy in 12, wedge resection in 16). Among these cases, intentional limited resections were done in 13 patients with GGO dominant group (tumor diameter ranged 7 to 20 mm), and they had no local recurrence. Prognosis of small-sized GGO dominant lung cancer is very favorable, so limited resection will be appropriate. But solid lesions, especially over 10 mm in tumor diameter, have possibility of LN involvement, lobectomy should be considered.
我们回顾了小尺寸非小细胞肺癌的手术结果。2004年至2007年,对109例直径2cm及以下的完全切除非小细胞肺癌患者进行了回顾性研究。其中男性65例,女性44例。年龄范围为41至87岁(中位年龄68岁)。总体5年生存率(OS)为89%,5年无病生存率(DFS)为82%。磨玻璃影(GGO)为主型组[高分辨率计算机断层扫描(CT)中GGO比例≥50%]和淋巴结(LN)阴性组的DFS明显较好。其他参数,如组织学、肿瘤直径、血清癌胚抗原(CEA)水平、胸膜侵犯、血管浸润、手术方式等,在DFS方面无显著差异。所有GGO为主型组患者(n = 23)均无LN转移且无病生存。有LN转移的病例[n = 10(9%)]均在实性组(GGO < 50%),且肿瘤直径超过10mm。28例行亚肺叶切除(12例行肺段切除,16例行楔形切除)。其中,13例GGO为主型组患者(肿瘤直径7至20mm)进行了意向性有限切除,且无局部复发。小尺寸GGO为主型肺癌的预后非常好,因此有限切除是合适的。但实性病变,尤其是肿瘤直径超过10mm的,有LN转移的可能,应考虑行肺叶切除。