Mimae Takahiro, Miyata Yoshihiro, Tsubokawa Norifumi, Kudo Yujin, Nagashima Takuya, Ito Hiroyuki, Ikeda Norihiko, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Ann Thorac Surg. 2025 Jan;119(1):192-198. doi: 10.1016/j.athoracsur.2024.03.013. Epub 2024 Mar 19.
The purpose of this study was to determine the optimal extent of lymph node dissection required in patients with small (≤3 cm) radiologically ground-glass opacity-dominant, peripheral, non-small cell lung cancer tumors.
The study analyzed the clinicopathologic findings and surgical outcomes of 988 patients with radiologic, ground-glass opacity-dominant non-small cell lung cancer without lymph node involvement who underwent complete resection of the primary tumor between 2010 and 2020. Patients were followed up for 54.5 months (median). Kaplan-Meier curves and the log-rank test were used in statistical analyses of the prognosis.
Median age, whole tumor size, solid tumor size, and maximum standardized uptake values were 68 years, 1.7 cm, 0.4 cm, and 0.9, respectively. Sixty percent of the cohort was female (n = 590). Wedge resection, segmentectomy, and lobectomy were performed in 206, 372, and 410 patients, respectively. A total of 982 of 988 (99%) tumors were adenocarcinomas. One patient had hilar lymph node involvement; however, no mediastinal lymph node metastasis or hilar or mediastinal lymph node recurrence was detected. The 5-year overall survival rate was 96.5% (95% CI, 94.8%-97.7%). Excellent survival outcomes were achieved regardless of procedure (wedge resection, 94.7% [95% CI, 89.1%-97.5%]; segmentectomy, 96.9% [95% CI, 93.7%-98.5%]; and lobectomy, 97.1% [95% CI, 94.4%-98.5%]).
Omitting lymph node dissection may be acceptable with curative intent for small tumors with radiologic ground-glass opacity dominance. Appropriate surgical procedures such as wedge resection, segmentectomy, or lobectomy can provide satisfactory outcomes in patients with indolent tumors if surgical margins are secured.
本研究的目的是确定对于影像学表现为磨玻璃影为主、外周型、肿瘤大小≤3 cm的非小细胞肺癌患者，所需的最佳淋巴结清扫范围。
本研究分析了988例在2010年至2020年间接受原发性肿瘤完整切除的影像学表现为磨玻璃影为主且无淋巴结受累的非小细胞肺癌患者的临床病理特征和手术结果。对患者进行了中位时间为54.5个月的随访。采用Kaplan-Meier曲线和对数秩检验对预后进行统计学分析。
患者的中位年龄、肿瘤总体大小、实性肿瘤大小和最大标准化摄取值分别为68岁、1.7 cm、0.4 cm和0.9。队列中60%为女性（n = 590）。分别有206例、372例和410例患者接受了楔形切除术、肺段切除术和肺叶切除术。988例患者中的982例（99%）肿瘤为腺癌。1例患者出现肺门淋巴结受累；然而，未检测到纵隔淋巴结转移或肺门或纵隔淋巴结复发。5年总生存率为96.5%（95%CI，94.8%-97.7%）。无论采用何种手术方式（楔形切除术，94.7%[95%CI，89.1%-97.5%]；肺段切除术，96.9%[95%CI，93.7%-98.5%]；肺叶切除术，97.1%[95%CI，94.4%-98.5%]）均取得了良好的生存结果。
对于影像学表现以磨玻璃影为主的小肿瘤，出于根治目的省略淋巴结清扫可能是可以接受的。如果能确保手术切缘，楔形切除术、肺段切除术等合适的手术方式可为惰性肿瘤患者提供满意的治疗效果。
