Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom.
Department of Pathology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom.
Cancer Treat Rev. 2021 Sep;99:102237. doi: 10.1016/j.ctrv.2021.102237. Epub 2021 May 29.
Adenocarcinoma has become the most prevalent lung cancer sub-type and its frequency is increasing. The earliest stages in the development of lung adenocarcinomas are visible using modern computed tomography (CT) as ground glass nodules. These pre-invasive nodules can progress over time to become invasive lung adenocarcinomas. Lesions in this developmental pathway are termed 'adenocarcinoma spectrum' lesions. With the introduction of lung cancer screening programs there has been an increase in the detection of these lesions raising questions about natural history, surveillance and treatment. Here we review how the radiological appearance of an adenocarcinoma spectrum lesion relates to its underlying pathology and explore the natural history and factors driving lesion progression. We examine the molecular changes that occur at each stage of adenocarcinoma spectrum lesion development, including the effects of the driver mutations, EGFR and KRAS, that are key to invasive adenocarcinoma pathology. A better understanding of the development of pre-invasive disease will create treatment targets. Our understanding of how tumours interact with the immune system has led to the development of new therapeutic strategies. We review the role of the immune system in the development of adenocarcinoma spectrum lesions. With a clear preinvasive phase there is an opportunity to treat early adenocarcinoma spectrum lesions before an invasive lung cancer develops. We review current management including surveillance, surgical resection and oncological therapy as well as exploring potential future treatment avenues.
腺癌已成为最常见的肺癌亚型，其发病率正在上升。现代计算机断层扫描（CT）可以发现肺癌腺癌发展的最早阶段，即磨玻璃结节。这些前侵袭性结节随着时间的推移可能会进展为侵袭性肺腺癌。该发展途径中的病变被称为“腺癌谱”病变。随着肺癌筛查计划的引入，这些病变的检出率有所增加，这引发了对其自然史、监测和治疗的疑问。在这里，我们回顾了腺癌谱病变的放射学表现与其潜在病理学的关系，并探讨了其自然史和病变进展的驱动因素。我们研究了腺癌谱病变发展过程中每个阶段发生的分子变化，包括驱动突变 EGFR 和 KRAS 的作用，这些突变是侵袭性腺癌病理学的关键。更好地了解早期疾病的发展将为治疗创造目标。我们对肿瘤与免疫系统相互作用的理解导致了新的治疗策略的发展。我们综述了免疫系统在腺癌谱病变发展中的作用。由于存在明确的早期侵袭前阶段，因此有机会在侵袭性肺癌发生之前治疗早期腺癌谱病变。我们回顾了目前的治疗方法，包括监测、手术切除和肿瘤治疗，并探讨了潜在的未来治疗途径。
