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中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 79 -84. doi: 10.3877/cma.j.issn.2095-8773.2024.02.01

指南与共识

2024年第1版美国国立综合癌症网络(NCCN)非小细胞肺癌指南手术部分解读
许宽1, 赵珩1, 叶波1,()   
  1. 1. 200030 上海,上海市胸科医院胸外科,上海交通大学医学院附属胸科医院
  • 收稿日期:2024-01-11 修回日期:2024-03-02 接受日期:2024-04-08 出版日期:2024-05-28
  • 通信作者: 叶波

Interpretation of the surgical section of the 2024 first edition of the National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer

Kuan Xu1, Heng Zhao1, Bo Ye1,()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2024-01-11 Revised:2024-03-02 Accepted:2024-04-08 Published:2024-05-28
  • Corresponding author: Bo Ye
引用本文:

许宽, 赵珩, 叶波. 2024年第1版美国国立综合癌症网络(NCCN)非小细胞肺癌指南手术部分解读[J]. 中华胸部外科电子杂志, 2024, 11(02): 79-84.

Kuan Xu, Heng Zhao, Bo Ye. Interpretation of the surgical section of the 2024 first edition of the National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(02): 79-84.

非小细胞肺癌(NSCLC)是一种常见的恶性肿瘤,手术切除是其主要的治疗手段。1995年北美肺癌研究小组发表的随机试验表明,在T1N0期肺癌患者中,与肺叶切除术相比,部分肺叶切除术局部复发率更高,生存率更低。此后,肺叶切除术就被认为是根治早期NSCLC的标准手术方式。然而,在20世纪后期,能够更大限度保留肺功能的部分肺叶切除术逐渐应用于肺癌的治疗。胸腔镜辅助和机器人辅助手术的应用也逐渐成为研究的热点。手术治疗的研究近年来取得了长足发展。本文针对2024年第1版美国国立综合癌症网络(NCCN)的NSCLC临床实践指南手术部分进行解读,从手术适应证、手术方式选择、淋巴结清扫策略等方面进行详细阐述,希望能够帮助外科医生更好地理解NSCLC的手术治疗原则和方法。

Non-small cell lung cancer (NSCLC) represents a prevalent malignant neoplasm, with surgical resection serving as its primary therapeutic modality. Following a pivotal randomized trial released by the North American Lung Cancer Study Group in 1995, which demonstrated a heightened local recurrence rate and diminished survival in T1N0 stage lung cancer patients undergoing segmentectomy compared to lobectomy, the latter has since been acknowledged as the established surgical approach for achieving curative outcomes in early-stage NSCLC. Nevertheless, during the latter part of the 20th century, segmentectomy, renowned for its optimization of lung function preservation, progressively gained traction in the landscape of lung cancer treatment. Furthermore, the exploration of thoracoscopic techniques and robot-assisted surgery has emerged as a focal point in research. Substantial advancements have been witnessed in the realm of surgical treatment for NSCLC in recent years. This article endeavors to expound upon the surgical section of the 2024 first edition of the National Comprehensive Cancer Network (NCCN) guidelines for NSCLC, offering intricate elucidations pertaining to surgical indications, methodologies, lymph node dissection strategies, etc. Its overarching objective is to facilitate a nuanced comprehension among surgeons regarding the underlying principles and methodologies governing NSCLC surgical interventions.

1
Siegel RLMiller KDJemal A.Cancer statistics, 2019[J].CA Cancer J Clin201969(1):7-34.
2
Gao SLi NWang S,et al.Lung Cancer in People's Republic of China[J].J Thorac Oncol202015(10):1567-1576.
3
Cahan WG.Radical lobectomy[J].J Thorac Cardiovasc Surg196039:555-572.
4
Strand TERostad HMøller B,et al.Survival after resection for primary lung cancer: a population based study of 3211 resected patients[J].Thorax200661(8):710-715.
5
Qiu CWang GXu J,et al.Sublobectomy versus lobectomy for stage I non-small cell lung cancer in the elderly[J].Int J Surg201737:1-7.
6
Yi ECho SKim K,et al.Comparison of survival outcomes between sublobar resection and lobectomies in early-stage lung adenocarcinoma by propensity score matching analysis[J].Indian J Thorac Cardiovasc Surg202036(4):382-387.
7
Wald OSadeh BMBdolah-Abram T,et al.Outcomes of sublobar resection vs lobectomy for invasive clinical stage T1N0 non-small-cell lung cancer: A propensity-match analysis[J].Cancer Rep (Hoboken)20214(3):e1339.
8
Nomori HYamazaki IMachida Y,et al.Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis[J].Interact Cardiovasc Thorac Surg202234(1):57-65.
9
Zhang BLiu RRen D,et al.Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching's Study[J].Front Oncol202111:610638.
10
Saji HOkada MTsuboi M,et al.Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J].Lancet2022399(10335):1607-1617.
11
Altorki NWang XKozono D,et al.Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer[J].N Engl J Med2023388(6):489-498.
12
Liang WHe JShen Y,et al.Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non-Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry[J].J Clin Oncol201735(11):1162-1170.
13
Akinbobola ORay MAFehnel C,et al.Institution-Level Evolution of Lung Cancer Resection Quality With Implementation of a Lymph Node Specimen Collection Kit[J].J Thorac Oncol202318(7):858-868.
14
Nagata YHiraoka MShibata T,et al.Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403[J].Int J Radiat Oncol Biol Phys201593(5):989-996.
15
van Meerbeeck JPKramer GWVan Schil PE,et al.Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer[J].J Natl Cancer Inst200799(6):442-450.
16
Albain KSSwann RSRusch VW,et al.Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial[J].Lancet2009374(9687):379-386.
17
Martins RGD'Amico TALoo BW Jr,et al.The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement[J].J Natl Compr Canc Netw201210(5):599-613.
18
Chang JYMehran RJFeng L,et al.Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery[J].Lancet Oncol202122(10):1448-1457.
19
Howington JABlum MGChang AC,et al.Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest2013143(5 Suppl):e278S-e313S.
20
Suzuki KAsamura HKusumoto M,et al."Early" peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan[J].Ann Thorac Surg200274(5):1635-1639.
21
Suzuki KKoike TAsakawa T,et al.A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201)[J].J Thorac Oncol20116(4):751-756.
22
Suzuki KWatanabe SIWakabayashi M,et al.A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer[J].J Thorac Cardiovasc Surg2022163(1):289-301.e2.
23
Aokage KSaji HSuzuki K,et al.A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211)[J].Gen Thorac Cardiovasc Surg201765(5):267-272.
24
中华医学会肿瘤学分会,中华医学会杂志社.中华医学会肺癌临床诊疗指南(2023版)[J].中华医学杂志2023103(27):2037-2074.
25
Darling GEAllen MSDecker PA,et al.Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial[J].J Thorac Cardiovasc Surg2011141(3):662-670.
26
Hishida TMiyaoka EYokoi K,et al.Lobe-Specific Nodal Dissection for Clinical Stage I and II NSCLC: Japanese Multi-Institutional Retrospective Study Using a Propensity Score Analysis[J].J Thorac Oncol201611(9):1529-1537.
27
Adachi HSakamaki KNishii T,et al.Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non-Small Cell Lung Cancer: A Propensity Score Matching Study[J].J Thorac Oncol201712(1):85-93.
28
Zhang YFu FWen Z,et al.Segment Location and Ground Glass Opacity Ratio Reliably Predict Node-Negative Status in Lung Cancer[J].Ann Thorac Surg2020109(4):1061-1068.
29
Zhang YDeng CZheng Q,et al.Selective Mediastinal Lymph Node Dissection Strategy for Clinical T1N0 Invasive Lung Cancer: A Prospective, Multicenter, Clinical Trial[J].J Thorac Oncol202318(7):931-939.
30
Edwards JGChansky KVan Schil P,et al.The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non-Small Cell Lung Cancer[J].J Thorac Oncol202015(3):344-359.
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