Woodard Gavitt A, Jablons David M
From the Department of Surgery, University of California, San Francisco, CA.
Am Soc Clin Oncol Educ Book. 2015:e435-41. doi: 10.14694/EdBook_AM.2015.35.e435.
Stage IIIA non-small cell lung cancer (NSCLC) remains a treatment challenge and requires a multidisciplinary care team to optimize survival outcomes. Thoracic surgeons play an important role in selecting operative candidates and assisting with pathologic mediastinal staging via cervical mediastinoscopy, endobronchial ultrasound, or esophageal ultrasound with fine needle aspiration. The majority of patients with stage IIIA disease will receive induction therapy followed by repeat staging before undergoing lobectomy or pneumonectomy; occasionally, a patient with an incidentally found, single-station microscopic IIIA tumor will undergo resection as the primary initial therapy. Multiple large clinical trials, including SWOG-8805, EORTC-8941, INT-0139, and ANITA, have shown 5-year overall survival rates of up to 30% to 40% using triple-modality treatments, and the best outcomes repeatedly are seen among patients who respond to induction treatment or who have tumors amenable to lobectomy instead of pneumonectomy. The need for a pneumonectomy is not a reason to deny patients an operation, because current operative mortality and morbidity rates are acceptably low at 5% and 30%, respectively. In select patients with stage IIIA disease, video-assisted thoracic surgery and open resections have been shown to have comparable rates of local recurrence and long-term survival. New developments in genetic profiling and personalized medicine are exciting areas of research, and early data suggest that molecular profiling of stage IIIA NSCLC tumors can accurately stratify patients by risk within this stage and predict survival outcomes. Future advances in treating stage IIIA disease will involve developing better systemic therapies and customizing treatment plans on the basis of an individual tumor's genetic profile.
ⅢA期非小细胞肺癌（NSCLC）仍然是一个治疗挑战，需要多学科护理团队来优化生存结果。胸外科医生在选择手术候选人以及通过颈部纵隔镜检查、支气管内超声或食管超声引导下细针穿刺协助进行纵隔病理分期方面发挥着重要作用。大多数ⅢA期疾病患者将接受诱导治疗，然后在进行肺叶切除术或全肺切除术之前再次进行分期；偶尔，偶然发现的单站微小ⅢA期肿瘤患者会接受手术切除作为主要初始治疗。包括SWOG - 8805、EORTC - 8941、INT - 0139和ANITA在内的多项大型临床试验表明，使用三联疗法的5年总生存率高达30%至40%，并且在对诱导治疗有反应或肿瘤适合肺叶切除术而非全肺切除术的患者中反复观察到最佳结果。需要进行全肺切除术并不是拒绝患者手术的理由，因为目前手术死亡率和发病率分别低至5%和30%，是可以接受的。在特定的ⅢA期疾病患者中，电视辅助胸腔镜手术和开放切除术已被证明局部复发率和长期生存率相当。基因谱分析和个性化医学的新进展是令人兴奋的研究领域，早期数据表明，ⅢA期NSCLC肿瘤的分子谱分析可以在该阶段内准确地按风险对患者进行分层并预测生存结果。治疗ⅢA期疾病的未来进展将包括开发更好的全身治疗方法，并根据个体肿瘤的基因谱定制治疗方案。
