Osaki Toshihiro, Yasumoto Kosei
Department of Chest Surgery, Iizuka Hospital, Iizuka, Japan.
Nihon Geka Gakkai Zasshi. 2013 Jan;114(1):28-33.
Clinical evaluation of micrometastases in the lymph nodes of lung cancer patients is not currently recommended in guidelines because of several different results concerning their prevalence and prognostic implications. However, a recent large, prospective, multicenter clinical study has shown a significant prognostic impact of micrometasteses in the lymph nodes of patients with resectable lung cancer; therefore, the clinical significance of micrometastases as predictive markers of recurrence and prognosis has begun to be clarified. From the viewpoint of surgery for lung cancer, sentinel node navigation surgery, segmentectomy, and individualized therapies such as adjuvant chemotherapy are expected to be developed. In the near future, standardization and improvement of the efficiency of diagnostic procedures will be necessary in common clinical practice. Recently, minimal residual cancer cell research, such as circulating tumor cells in the peripheral blood and disseminated tumor cells in the bone marrow, has made good progress. As research in this field continues, it is expected that the mechanism of metastasis and novel therapeutic strategies targeting minimal residual cancer cells will become better understood.
目前，由于肺癌患者淋巴结微转移的患病率及预后意义存在多种不同结果，指南不建议对其进行临床评估。然而，最近一项大型、前瞻性、多中心临床研究表明，微转移对可切除肺癌患者的淋巴结具有显著的预后影响；因此，微转移作为复发和预后预测标志物的临床意义已开始得到阐明。从肺癌手术的角度来看，预计将开展前哨淋巴结导航手术、肺段切除术以及辅助化疗等个体化治疗。在不久的将来，普通临床实践中需要对诊断程序进行标准化并提高其效率。最近，外周血循环肿瘤细胞和骨髓中播散肿瘤细胞等最小残留癌细胞研究取得了良好进展。随着该领域研究的持续进行，预计转移机制以及针对最小残留癌细胞的新型治疗策略将得到更好的理解。
