Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.
Division of Endoscopy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Eur J Cardiothorac Surg. 2018 Apr 1;53(4):849-856. doi: 10.1093/ejcts/ezx418.
The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO.
The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed.
From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal.
With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.
磨玻璃密度（GGO）的小尺寸肺腺癌的发病率最近有所增加，且术后预后良好。基于回顾性研究，此类癌症的局限性切除被认为是可以接受的。我们进行了一项前瞻性多机构研究，以评估对 GGO 小尺寸肺腺癌进行局限性切除的有效性。
纳入标准为年龄 25-80 岁，未经治疗，最大肿瘤直径 8-20mm，GGO 比例≥80%，临床 T1N0M0，18F-氟脱氧葡萄糖摄取低于纵隔，可亚肺叶切除，能耐受肺叶切除术，术中病理诊断为细支气管肺泡癌。楔形切除术优先，但也可进行节段切除术。分析疾病特异性生存率和总生存率。
2006 年 11 月至 2012 年 4 月，从 13 个机构共纳入 73 例患者。1 例患者不符合条件，其余 72 例患者预注册。13 例患者术中诊断为良性病变，14 例患者术中诊断为混合亚型腺癌。2 例患者未行术中外科切缘细胞学/组织学检查，其余 53 例患者最终符合本研究条件。肿瘤平均大小为 14.0mm，GGO 比例平均为 95.9%。39 例患者行楔形切除术，14 例患者行节段切除术。尽管所有肿瘤术中均诊断为细支气管肺泡癌，但最终有 6 例诊断为混合亚型腺癌。未行全肺切除术。截至 2017 年 5 月 1 日，术后 60.0-126.3 个月未观察到原肺癌复发。2 例患者死于其他疾病。5 年疾病特异性生存率和总生存率分别为 100%和 98.1%。局限性切除后肺功能下降很小。
符合这些标准的局限性切除安全无复发，术后肺功能得到很好的保留。符合本研究标准的 GGO 小尺寸肺癌局限性切除的结果令人满意。
