Predina Jarrod D, Keating Jane, Patel Neil, Nims Sarah, Singhal Sunil
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Surg Oncol. 2016 Mar;113(3):264-9. doi: 10.1002/jso.24130. Epub 2015 Dec 30.
Positive margins following pulmonary resection of non-small cell lung cancer (NSCLC) occur in approximately 5-15% of patients undergoing a curative procedure. The presence of positive margins negatively impacts long-term outcomes by setting the stage for local and potentially distant disease recurrence. Despite major clinical ramifications, there are very few dedicated reports that examine the implications of positive margins following surgery for NSCLC. Furthermore, published series are typically retrospective studies from single institutions. In this review we analyze published data with special consideration of four pertinent questions: (i) what are the long term outcomes of a positive margin following pulmonary resection?, (ii) is intraoperative margin assessment by frozen section reliable?, (iii) what is the optimal distance of the tumor margin to the surgical margin?, and (iv) should adjuvant chemotherapy and/or radiation therapy be used in the setting of a positive surgical margin?
在接受根治性手术的非小细胞肺癌（NSCLC）患者中，肺切除术后切缘阳性的发生率约为5%-15%。切缘阳性会为局部及潜在的远处疾病复发埋下隐患，从而对长期预后产生负面影响。尽管存在重大临床影响，但专门研究NSCLC手术后切缘阳性影响的报告却非常少。此外，已发表的系列研究通常是来自单一机构的回顾性研究。在本综述中，我们分析已发表的数据，并特别考虑四个相关问题：（i）肺切除术后切缘阳性的长期预后如何？（ii）术中冰冻切片评估切缘是否可靠？（iii）肿瘤边缘与手术切缘的最佳距离是多少？（iv）手术切缘阳性时是否应使用辅助化疗和/或放疗？
