非小细胞肺癌磨玻璃影行肺段切除术的可行性
Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity.
作者信息
Iwata Hisashi, Shirahashi Koyo, Mizuno Yoshimasa, Yamamoto Hirotaka, Takemura Hirofumi
机构信息
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
出版信息
Eur J Cardiothorac Surg. 2014 Sep;46(3):375-9; discussion 379. doi: 10.1093/ejcts/ezu021. Epub 2014 Feb 20.
OBJECTIVES
Recently, lung segmental resection has been increasingly performed in patients with lung cancer. In this study, the results of radical segmentectomy (RS) and palliative segmentectomy (PS) were compared retrospectively.
METHODS
Segmentectomy was performed to remove a primary lung cancer in 87 cases. RS was performed for pure ground-glass opacity (GGO), >50% GGO and diameter less than 2 cm and less than 10 mm solid tumours. PS was performed in patients with poor lung function or relapse, or at high risk for surgery. A total of 84 cases, excluding 3 cases of relapse, were investigated.
RESULTS
The pathological stage of RS was IA in 32 (94.1%) and IB in 2 (5.9%). The pathological stage of PS was IA in 23 (46.0%), IB in 15 (30.0%), IIA in 5 (10.0%), IIB in 1 (2.0%), IIIA in 4 (8.0%) and IV in 2 (4.0%). The preoperative characteristics of RS were compared with those of PS for pathological stage I. The mean age was significantly lower for RS cases (67.4 ± 9.9 years) than for PS cases (73.0 ± 9.0 years; P = 0.013). Tumour size was significantly smaller in RS cases (14.7 ± 4.6 mm) than in PS cases (22.0 ± 8.9 mm; P < 0.001). The tumour standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography was significantly lower in RS cases (1.2 ± 1.6) than in PS cases (6.0 ± 6.1; P < 0.001). Serum carcinoembryonic antigen level was lower in RS cases (2.8 ± 1.8 ng/ml) than in PS cases (4.9 ± 5.0; P = 0.019). The mean duration of drainage was shorter in RS (2.5 ± 0.7 days) than in PS (3.9 ± 2.6 days; P = 0.004). Postoperative complications occurred in 6 RS cases (17.6%) and 12 PS cases (29.3%). Overall 5-year survival was higher in RS (100%) than in PS (66.2%; P = 0.003). Five-year disease-free survival was higher in RS (100%) than in PS (66.2%; P = 0.002). Recurrence was detected in 6 PS patients; 10 PS cases showed tumour with GGO and survived without recurrence.
CONCLUSIONS
Our RS is feasible for stage I lung cancer with specific computed tomography features, such as small size, GGO or peripheral location.
目的
近年来，肺癌患者越来越多地接受肺段切除术。在本研究中，对根治性肺段切除术（RS）和姑息性肺段切除术（PS）的结果进行了回顾性比较。
方法
对87例原发性肺癌患者实施了肺段切除术。RS适用于纯磨玻璃影（GGO）、GGO占比>50%且直径小于2 cm以及实性肿瘤小于10 mm的情况。PS适用于肺功能差、复发或手术风险高的患者。共调查了84例患者，排除3例复发患者。
结果
RS的病理分期为IA期32例（94.1%），IB期2例（5.9%）。PS的病理分期为IA期23例（46.0%），IB期15例（30.0%），IIA期5例（10.0%），IIB期1例（2.0%），IIIA期4例（8.0%），IV期2例（4.0%）。比较了RS和PS在病理I期患者的术前特征。RS组患者的平均年龄（67.4±9.9岁）显著低于PS组（73.0±9.0岁；P = 0.013）。RS组的肿瘤大小（14.7±4.6 mm）显著小于PS组（22.0±8.9 mm；P < 0.001）。18F-氟脱氧葡萄糖正电子发射断层扫描的肿瘤标准化摄取值在RS组（1.2±1.6）显著低于PS组（6.0±6.1；P < 0.001）。RS组的血清癌胚抗原水平（2.8±1.8 ng/ml）低于PS组（4.9±5.0；P = 0.019）。RS组的平均引流时间（2.5±0.7天）短于PS组（3.9±2.6天；P = 0.004）。RS组6例（17.6%）和PS组12例（29.3%）发生了术后并发症。RS组的总体5年生存率（100%）高于PS组（66.2%；P = 0.003）。RS组的5年无病生存率（100%）高于PS组（66.2%；P = 0.002）。6例PS患者出现复发；10例PS患者的肿瘤有GGO且存活无复发。
结论
我们的RS对于具有特定计算机断层扫描特征（如体积小、GGO或位于周边）的I期肺癌是可行的。
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