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中华胸部外科电子杂志 ›› 2025, Vol. 12 ›› Issue (03) : 162 -175. doi: 10.3877/cma.j.issn.2095-8773.2025.03.06

综述

早期非小细胞肺癌亚肺叶切除的研究进展
陈宇韬, 沈建飞(), 马德华   
  1. 317000 临海,温州医科大学附属台州医院心胸外科
  • 收稿日期:2025-03-27 修回日期:2025-05-14 接受日期:2025-05-16 出版日期:2025-08-28
  • 通信作者: 沈建飞
  • 基金资助:
    浙江省自然科学基金(LTGY23H160028)

Research advances in sublobar resection for early-stage non small cell lung cancer

Yutao Chen, Jianfei Shen(), Dehua Ma   

  1. Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China
  • Received:2025-03-27 Revised:2025-05-14 Accepted:2025-05-16 Published:2025-08-28
  • Corresponding author: Jianfei Shen
引用本文:

陈宇韬, 沈建飞, 马德华. 早期非小细胞肺癌亚肺叶切除的研究进展[J/OL]. 中华胸部外科电子杂志, 2025, 12(03): 162-175.

Yutao Chen, Jianfei Shen, Dehua Ma. Research advances in sublobar resection for early-stage non small cell lung cancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2025, 12(03): 162-175.

随机对照试验日本临床肿瘤学组(JCOG)0802和白血病研究组B(CALGB)140503的结果证实,对于直径≤2 cm的早期非小细胞肺癌患者,亚肺叶切除的预后与肺叶切除术相同。然而,亚肺叶切除术在实际临床工作中的应用仍存在争议。本综述将这些争议归纳为4点:高危病理因素对亚肺叶切除安全性的影响、亚肺叶切除术中的淋巴结清扫、亚肺叶切除术中影响局部复发的因素以及亚肺叶切除的生活质量获益。本综述归纳了对这些争议的研究进展,以期为亚肺叶切除在临床工作中的应用提供参考。

The results of the randomized controlled trials, Japan Clinical Oncology Group (JCOG) 0802 and Cancer and Leukemia Group B (CALGB) 140503, have demonstrated that sublobar resection offers comparable prognosis to lobectomy for patients with early-stage non-small cell lung cancer (NSCLC) with tumors ≤2 cm in diameter. However, the application of sublobar resection in clinical practice remains controversial. This review summarizes these controversies into four key points: the impact of high-risk pathological factors on the safety of sublobar resection, lymph node dissection during sublobar resection, factors influencing local recurrence in sublobar resection, and the benefits to quality of life from sublobar resection. We summarize the research progress on these controversies to provide insights for the clinical application of sublobar resection.

表1 VPI患者肺叶切除与亚肺叶切除的对照研究
表2 含高级别成分的肺腺癌患者肺叶切除与亚肺叶切除的对照研究
表3 STAS患者肺叶切除和肺段切除的对照研究
表4 OLNM患者肺叶切除与亚肺叶切除的对照研究
图1 VPI患者肺段切除和肺叶切除预后的荟萃分析结果。CI:置信区间;VPI:脏层胸膜侵犯;SE:标准误
图2 VPI患者楔形切除和肺叶切除预后的荟萃分析结果。CI:置信区间;VPI:脏层胸膜侵犯;SE:标准误
图3 含高级别成分的肺腺癌患者肺段切除和肺叶切除预后的荟萃分析结果。CI:置信区间;SE:标准误
图4 含高级别成分的肺腺癌患者楔形切除和肺叶切除预后的标准误分析结果。CI:置信区间;SE:标准误
图5 STAS患者肺段切除和肺叶切除预后的荟萃分析结果。STAS:气道内播散;CI:置信区间;SE:标准误
图6 OLNM患者肺段切除和肺叶切除预后的荟萃分析结果。CI:置信区间;OLNM:隐匿性淋巴结转移;SE:标准误
图7 综合考虑高危病理成分,CTR和肿瘤直径的早期NSCLC手术决策。CTR:实变/肿瘤比;VPI:脏层胸膜侵犯;STAS:气道内播散;OLNM:隐匿性淋巴结转移;LVI:脉管侵犯;NSCLC:非小细胞肺癌
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