Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
Semin Thorac Cardiovasc Surg. 2022 Autumn;34(3):1093-1099. doi: 10.1053/j.semtcvs.2021.06.024. Epub 2021 Jul 1.
This study investigated treatment strategy for suspicious lung cancer with postoperatively proven benign etiology. In this retrospective study, we collected patients who underwent pulmonary resection for radiologically suspected lung cancer from 2010 to 2019 at Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC). Radiological features, preoperative follow-up time, preoperative pathology and postoperative pathology of these patients were documented. We classified resected benign lesions based on paraffin section and compared the therapy management performed on indeterminate lung nodules of 2 time periods (2010-2014 vs 2015-2019). 17,188 patients were included in this cohort and 1,381 (8.03%) cases were postoperatively proved to be benign lesions. Resected benign lesions proportion significantly decreased by years, from 14.5-6.2%. The respective resected benign lesions proportions for pure GGO nodules, part solid nodules and solid nodules were 5.3%, 3.0% and 11.7%. The resected benign lesions rate for patients with longer preoperative follow-up time was much lower (p < 0.001). Among the benign lesions, 14.2% were benign tumors, 25.7% were granulomatous, 30.2% were pneumonia, 18.0% were fibrosis and 11.9% were other types. If we consider that resections for granulomatous and pneumonia radiologically featured as solid nodules exceeding 2 cm, benign tumor and inflammatory pseudotumor are therapeutic, the nontherapeutic pulmonary resection rate is 4.26%. For patients with GGO nodules, the median preoperative follow-up time increased with the time being and the resected benign rate in period 2 (2015-2019) was significantly lower than that in period 1 (2010-2014). Wedge resection was the most common surgery strategy especially for small nodules and no matter for small or large nodules, the frequency of sublobar resection in period 2 was higher than that in period 1. The resected benign lesions rate at our department was relatively low and decreasing over the last decade. Meanwhile, our follow-up and surgical strategy improved over time. For patients with GGO nodules, 4-6months preoperative follow-up is recommended to avoid surgical intervention for benign lesions. For solid nodules with inconclusive diagnosis, limited resection should be first considered to maintain the balance between reducing the risk of cancer progressing and minimizing the resection for benign lesions.
本研究探讨了术后证实良性病因的疑似肺癌的治疗策略。在这项回顾性研究中，我们收集了 2010 年至 2019 年在复旦大学附属肿瘤医院胸外科接受肺部切除术治疗影像学疑似肺癌的患者。记录了这些患者的影像学特征、术前随访时间、术前病理和术后病理。我们根据石蜡切片将切除的良性病变进行分类，并比较了 2 个时间段（2010-2014 年与 2015-2019 年）对不确定肺结节的治疗管理。该队列共纳入 17188 例患者，其中 1381 例（8.03%）术后证实为良性病变。切除的良性病变比例随年份显著下降，从 14.5%降至 6.2%。纯磨玻璃结节、部分实性结节和实性结节的切除良性病变比例分别为 5.3%、3.0%和 11.7%。术前随访时间较长的患者切除良性病变的比例明显较低（p<0.001）。在良性病变中，14.2%为良性肿瘤，25.7%为肉芽肿性，30.2%为肺炎，18.0%为纤维化，11.9%为其他类型。如果我们认为切除直径超过 2cm 的影像学表现为实性结节的肉芽肿性和肺炎性病变是有治疗意义的，那么非治疗性肺切除术的比例为 4.26%。对于磨玻璃结节患者，术前中位随访时间随时间推移而增加，且 2 期（2015-2019 年）切除的良性率明显低于 1 期（2010-2014 年）。楔形切除术是最常见的手术策略，尤其是对于小结节，而且无论结节大小，2 期亚肺叶切除术的频率均高于 1 期。过去十年间，我院切除的良性病变比例相对较低且呈下降趋势。同时，我们的随访和手术策略也随着时间的推移而不断改进。对于磨玻璃结节患者，建议术前随访 4-6 个月，以避免对良性病变进行手术干预。对于诊断不确定的实性结节，应首先考虑局限性切除，以在降低癌症进展风险和最小化良性病变切除之间保持平衡。
