*Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY; †Department of Pathology, Weill Cornell Medical College, New York, NY; and ‡Department of Thoracic Surgery, Weill Cornell Medical College, New York, NY.
J Thorac Oncol. 2014 May;9(5):685-91. doi: 10.1097/JTO.0000000000000143.
Five-year survival rates for resected stage I adenocarcinoma approach 100%. Given previous studies describing the prolonged indolent natural history of ground-glass lesions suspicious for early adenocarcinoma, our purpose in this study was to determine if outcomes were different among patients who were observed for radiographic and biopsy suspected early adenocarcinoma compared with those who were resected immediately.
We identified 63 patients with no prior history of lung adenocarcinoma who had undergone computer tomography-guided fine-needle aspiration of ground-glass opacities with cytology concerning for new early adenocarcinoma between January 2002 and December 2011. We compared the clinical outcomes of patients who were resected after abnormal cytology results and those who opted for watchful waiting.
Sixteen patients elected to observe their ground-glass nodules despite having suspicious cytology results, whereas 47 opted for immediate resection. Of the 16 observed patients, six (37.5%) ultimately demonstrated growth or increase solid component of the ground-glass nodule. Five of these patients elected for definitive therapy by surgical resection or radiation. There were no occurrences of distant metastasis or lung cancer-associated deaths in the observed group. Of the 47 resected patients, two developed metastatic disease, five developed new cancers in remaining lung, and three developed progression in existing ground-glass nodules.
Ground-glass lesions that were observed after biopsy did not demonstrate any increased rates of metastasis or cancer-related deaths and delayed resection does not seem to have a negative effect on outcomes.
切除的 I 期腺癌的 5 年生存率接近 100%。鉴于之前的研究描述了磨玻璃样病变具有早期腺癌的惰性自然病史，我们的研究目的是确定与立即切除相比，对疑似早期腺癌的影像学和活检进行观察的患者的结局是否不同。
我们确定了 63 例无肺癌病史的患者，他们在 2002 年 1 月至 2011 年 12 月期间接受了 CT 引导下的磨玻璃样阴影细针抽吸术，细胞学检查显示新的早期腺癌。我们比较了细胞学异常结果后接受手术切除和选择观察等待的患者的临床结局。
16 例患者尽管细胞学结果可疑，但选择观察其磨玻璃结节，而 47 例患者选择立即切除。在观察的 16 例患者中，有 6 例（37.5%）最终显示磨玻璃结节的生长或实性成分增加。其中 5 例患者选择手术切除或放疗进行明确治疗。观察组中没有发生远处转移或肺癌相关死亡。在 47 例切除的患者中，有 2 例发生转移性疾病，5 例在剩余的肺中发生新的癌症，3 例现有的磨玻璃结节进展。
活检后观察的磨玻璃样病变没有表现出任何增加的转移率或癌症相关死亡率，延迟切除似乎对结局没有负面影响。
