Japanese Northern East Area Thoracic Surgery Study Group (JNETS); Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan.
Japanese Northern East Area Thoracic Surgery Study Group (JNETS); Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan.
Ann Thorac Surg. 2014 Jul;98(1):258-64. doi: 10.1016/j.athoracsur.2014.01.052. Epub 2014 Apr 18.
Purely localized, oligometastatic, and widely metastatic tumors are likely to require different therapeutic strategies. Although surgical procedures for isolated pulmonary, brain, or adrenal metastases from lung cancer have been extensively evaluated, most data are from retrospective studies; accordingly, we conducted a prospective multicenter trial.
Patients were eligible if they had previously untreated clinical T1-2N0-1 lung cancer with single-organ metastasis, or single-organ metachronous metastasis after complete resection of pathologic T1-2N0-1 lung cancer. Metastatic lesions were classified into three groups: group A included metastasis in single organs other than brain or lung; group B included synchronous brain metastasis; and group C included pulmonary metastasis. The treatment intervention was surgical resection of metachronous metastasis or of both synchronous metastasis and primary lung cancer.
From December 2002 through June 2011, 36 patients were enrolled. Two patients were ineligible, and the remaining 34 were analyzed; 6 (18%) had a benign lesion and no metastasis, 5 patients (15%) underwent incomplete resection of primary lung cancer, and 20 patients (59%) underwent complete resection of both primary lung cancer and metastasis. The 5-year survival rate for these 20 cases was 44.7%.
Clinical T1-2N0-1 lung cancer with a single-organ metastatic lesion was a good candidate for surgical resection. A 5-year survival rate of about 40% can be expected, which could be comparable with that for stage II non-small cell lung cancer.
单纯局部、寡转移和广泛转移的肿瘤可能需要不同的治疗策略。虽然肺癌孤立性肺、脑或肾上腺转移的手术治疗已经得到广泛评估，但大多数数据来自回顾性研究；因此，我们进行了一项前瞻性多中心试验。
如果患者患有未经治疗的临床 T1-2N0-1 期肺癌，且有单一器官转移，或 T1-2N0-1 期肺癌完全切除后的单一器官异时性转移，则符合入组条件。转移病灶分为三组：A 组包括脑或肺以外的单一器官转移；B 组包括同步脑转移；C 组包括肺转移。治疗干预是对异时性转移或同步转移和原发性肺癌进行手术切除。
从 2002 年 12 月至 2011 年 6 月，共纳入 36 例患者。有 2 例患者不符合条件，其余 34 例患者进行了分析；6 例（18%）为良性病变且无转移，5 例（15%）患者原发性肺癌未完全切除，20 例（59%）患者原发性肺癌和转移灶均完全切除。这 20 例患者的 5 年生存率为 44.7%。
临床 T1-2N0-1 期肺癌伴单一器官转移灶是手术切除的良好适应证。预计 5 年生存率约为 40%，与 II 期非小细胞肺癌相当。
