Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York 10016, USA.
Semin Thorac Cardiovasc Surg. 2013 Spring;25(1):22-9. doi: 10.1053/j.semtcvs.2013.01.005.
The Lung Cancer Study Group consensus recommending lobectomy for stage I non-small-cell lung cancer (NSCLC) to reduce local recurrence associated with sublobar resections has directed NSCLC care since its 1995 publication. However, enhancements in imaging technology and in our understanding of the molecular biology of NSCLC over the past 2 decades have produced large cohorts of patients with smaller, better staged, and more indolent tumors than evaluated by the Lung Cancer Study Group. Numerous single-institution trials have demonstrated that in well-selected patients, sublobar resection can afford comparable survival and recurrence rates with lobectomy with a more favorable risk profile. This review of recent literature will focus on 2 separate issues with regard to the use of sublobar resections for stage I NSCLC: (1) a comparison to nonoperative ablative therapies in medically unfit patients, and (2) identifying in which subset of the noncompromised standard-risk population, sublobar resections provide equivalent outcome to lobectomy.
肺癌研究组的共识建议对 I 期非小细胞肺癌（NSCLC）进行肺叶切除术以降低亚肺叶切除相关的局部复发率，自 1995 年发表以来一直指导着 NSCLC 的治疗。然而，过去 20 年来，影像学技术和对 NSCLC 分子生物学的理解得到了增强，产生了大量的患者，这些患者的肿瘤比肺癌研究组评估的肿瘤体积更小、分期更好、惰性更强。许多单中心试验已经证明，在精心选择的患者中，与肺叶切除术相比，亚肺叶切除术可以提供相似的生存和复发率，并且风险状况更为有利。本综述将重点讨论亚肺叶切除术治疗 I 期 NSCLC 的两个方面：（1）与不适合手术的消融治疗方法在不适合手术的患者中的比较；（2）确定在非受损标准风险人群的哪个亚组中，亚肺叶切除术提供与肺叶切除术相当的结果。
