Manzano Carlos, Fuentes-Martín Álvaro, Zuil Maria, Gil Barturen Mariana, González Jessica, Cilleruelo-Ramos Ángel
Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lérida, España.
Servicio de Cirugía Torácica, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, España.
Open Respir Arch. 2023 Sep 1;5(3):100264. doi: 10.1016/j.opresp.2023.100264. eCollection 2023 Jul-Sep.
Over the past 2 decades, scientific evidence has strongly supported the use of low-radiation dose chest computed tomography (CT) as a screening technique for lung cancer. This approach has resulted in a significant reduction in mortality rates by enabling the detection of early-stage lung cancer amenable to potentially curative treatments. Regarding diagnosis, there are also novel methods under study, such as liquid biopsy, identification of the pulmonary microbiome, and the use of artificial intelligence techniques, which will play a key role in the near future. At present, there is a growing trend towards less invasive surgical procedures, such as segmentectomy, as an alternative to lobectomy. This procedure is based on 2 recent clinical trials conducted on peripheral tumors measuring less than 2 cm. Although these approaches have demonstrated comparable survival rates, there remains controversy due to uncertainties surrounding recurrence rates and functional capacity preservation. With regard to adjuvant therapy, immunotherapy, either as a monotherapy or in conjunction with chemotherapy, has shown encouraging results in resectable stages of locally advanced lung cancer, demonstrating complete pathologic responses and improved overall survival.After surgery treatment, despite the lack of solid evidence for long-term follow-up of these patients, clinical practice recommends periodic CT scans during the early years.In conclusion, there have been significant advances in lung cancer that have improved diagnostic techniques using new technologies and screening programs. Furthermore, the treatment of lung cancer is increasingly personalized, resulting in an improvement in the survival of patients.
在过去20年中,科学证据有力地支持了使用低辐射剂量胸部计算机断层扫描(CT)作为肺癌筛查技术。这种方法通过能够检测出适合进行潜在治愈性治疗的早期肺癌,使死亡率显著降低。在诊断方面,也有一些新方法正在研究中,如液体活检、肺部微生物群的鉴定以及人工智能技术的应用,这些在不久的将来将发挥关键作用。目前,作为肺叶切除术的替代方法,诸如肺段切除术等侵入性较小的外科手术有增加的趋势。该手术基于最近对直径小于2厘米的周围型肿瘤进行的两项临床试验。尽管这些方法已显示出相当的生存率,但由于复发率和功能保留方面存在不确定性,仍存在争议。关于辅助治疗,免疫疗法无论是作为单一疗法还是与化疗联合使用,在局部晚期肺癌的可切除阶段都显示出令人鼓舞的结果,表现出完全的病理反应并改善了总生存期。手术后,尽管缺乏对这些患者进行长期随访的确凿证据,但临床实践建议在早期进行定期CT扫描。总之,肺癌领域已取得重大进展,利用新技术和筛查项目改进了诊断技术。此外,肺癌治疗越来越个性化,从而提高了患者的生存率。