基于病理差异的非小细胞肺癌有限切除的结果
The Outcomes of a Limited Resection for Non-Small Cell Lung Cancer Based on Differences in Pathology.
作者信息
Yano Motoki, Yoshida Junji, Koike Terumoto, Kameyama Kotaro, Shimamoto Akira, Nishio Wataru, Yoshimoto Kentaro, Utsumi Tomoki, Shiina Takayuki, Watanabe Atsushi, Yamato Yasushi, Watanabe Takehiro, Takahashi Yusuke, Sonobe Makoto, Kuroda Hiroaki, Oda Makoto, Inoue Masayoshi, Tanahashi Masayuki, Adachi Hirofumi, Saito Masao, Hayashi Masataro, Otsuka Hajime, Mizobuchi Teruaki, Moriya Yasumitsu, Takahashi Mamoru, Nishikawa Shigeto, Matsumura Yuki, Moriyama Satoru, Fujii Yoshitaka
机构信息
Department of Oncology, Immunology and Surgery, Nagoya City, University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
出版信息
World J Surg. 2016 Nov;40(11):2688-2697. doi: 10.1007/s00268-016-3596-9.
OBJECTIVE
A precise preoperative diagnosis of in situ or minimally invasive carcinoma may identify patients who can be treated by limited resection. Although some clinical trials of limited resection for lung cancer have started, it will take a long time before the results will be published. We have already reported a large-scale study of limited resection. We herein report the data for a subclass analysis according to differences in pathology.
METHODS
Data from multiple institutions were collected on 1710 patients who had undergone limited resection (segmentectomy or wedge resection) for cT1N0M0 non-small cell carcinoma. The disease-free survival (DFS) and recurrence-free proportion (RFP) were analyzed. Small cell carcinomas and carcinoid tumors were excluded from this analysis. Adenocarcinomas were sub-classified into four groups using two factors, the ratio of consolidation to the tumor diameter (C/T) and the tumor diameter alone.
RESULTS
The median patient age was 64 (20-75) years old. The mean maximal diameter of the tumors was 1.5 ± 0.5 cm. The DFS and RFP at 5 years based on the pathology were 92.2 and 94.7 % in adenocarcinoma (n = 1575), 76.3 and 82.4 % in squamous cell carcinoma (SqCC) (n = 100), and 73.6 and 75.9 % in patients with other tumors (n = 35). The prognosis of adenocarcinoma in both groups A (C/T ≤0.25 and tumor diameter ≤2.0 cm) and B (C/T ≤0.25 and tumor diameter >2.0 cm) was good. In SqCC, only segmentectomy was a favorable prognostic factor. In the groups with other pathologies, large cell carcinomas were worse in prognosis (the both DFS and RFP: 46.3 %).
CONCLUSION
Knowing the pathological diagnosis is important to determine the indications for limited resection. Measurement of the tumor diameter and C/T was useful to determine the indications for limited resection for adenocarcinoma. Limited resection for adenocarcinomas is similar with a larger resection, while the technique should be performed with caution in squamous cell carcinoma and other pathologies.
目的
原位癌或微浸润癌的精确术前诊断可识别出能够接受局限性切除治疗的患者。尽管一些肺癌局限性切除的临床试验已经启动，但结果公布尚需时日。我们已经报道了一项关于局限性切除的大规模研究。在此，我们根据病理差异报告亚组分析的数据。
方法
收集了多个机构中1710例接受cT1N0M0非小细胞癌局限性切除（肺段切除术或楔形切除术）患者的数据。分析无病生存期（DFS）和无复发生存率（RFP）。小细胞癌和类癌肿瘤被排除在本分析之外。腺癌根据两个因素分为四组，实变与肿瘤直径之比（C/T）和单独的肿瘤直径。
结果
患者中位年龄为64（20 - 75）岁。肿瘤平均最大直径为1.5±0.5cm。基于病理的5年DFS和RFP在腺癌（n = 1575）中分别为92.2%和94.7%，在鳞状细胞癌（SqCC，n = 100）中分别为76.3%和82.4%，在其他肿瘤患者（n = 35）中分别为73.6%和75.9%。A组（C/T≤0.25且肿瘤直径≤2.0cm）和B组（C/T≤0.25且肿瘤直径>2.0cm）腺癌的预后均良好。在SqCC中，只有肺段切除术是一个有利的预后因素。在其他病理类型的组中，大细胞癌的预后较差（DFS和RFP均为46.3%）。
结论
了解病理诊断对于确定局限性切除的适应证很重要。测量肿瘤直径和C/T对于确定腺癌局限性切除的适应证很有用。腺癌的局限性切除与更大范围的切除效果相似，而在鳞状细胞癌和其他病理类型中进行该技术时应谨慎操作。
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