中国癌症杂志 ›› 2024, Vol. 34 ›› Issue (4): 335-339.doi: 10.19401/j.cnki.1007-3639.2024.04.001

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2023年度肺癌外科治疗领域重要进展

钱斌1,2(), 陈海泉1,3()   

  1. 1.复旦大学附属肿瘤医院胸外科,复旦大学上海医学院肿瘤学系,上海 200032
    2.扬州市江都人民医院胸外科,江苏 扬州 225000
    3.复旦大学胸部肿瘤研究所,上海 200032
  • 收稿日期:2024-03-28 修回日期:2024-04-28 出版日期:2024-04-30 发布日期:2024-05-17
  • 通信作者: 陈海泉(ORCID: 0000-0003-1689-0549),博士,二级教授、主任医师、博士研究生导师,复旦大学附属肿瘤医院胸外科主任。
  • 作者简介:钱斌(ORCID: 0009-0007-9228-9962),主任医师,扬州市江都人民医院胸外科主任。
    陈海泉,医学博士、主任医师、二级教授、博士研究生导师。现任复旦大学胸部肿瘤研究所所长,复旦大学附属肿瘤医院胸外科主任、胸部肿瘤多学科诊治组首席专家、肺癌防治中心主任。曾任上海市胸科医院院长。现为美国胸外科学会会员、教育委员会委员、会员发展委员会委员、美国胸外科学会胸外科临床实践标准委员会委员、美国胸外科学会GGO肺癌处理专家共识主席、哈佛大学Schuster Distinguished Lectureship、中国医师协会胸外科医师分会副会长、中国抗癌协会肺癌专业委员会常委、食管癌专业委员会常委、上海医学会胸外科分会主任委员、上海市抗癌协会肺癌专委会主任委员、上海市领军人才、上海市优秀学科带头人。目前任The Journal of Thoracic and Cardiovascular Surgery编委,Journal of Cancer Research and Clinical OncologyAnnals of Surgical OncologyJTO Clinical and Research Reports副主编。在国际上创新性地提出了“肺癌微创3.0”、“冰冻病理指导亚肺叶切除”和“肺癌手术的选择性淋巴结清扫”。2013—2023年连续每年应邀至AATS讲课,2016年担任AATS第96届年会Skill Course的共同主席、2016年AATS Focus on Thoracic Surgery:China主席,2017年第9届亚洲胸外科俱乐部(ATSC)和韩国胸外科肿瘤协会(KATSO)联席会议副主席,2008年起先后多次应邀在美国匹兹堡大学医学中心、美国哈佛大学麻省总医院、美国纽约纪念斯隆-凯特林癌症中心、美国范德堡大学医学中心、瑞士苏黎世大学医学中心、比利时鲁汶大学医学中心授课。2020年在美国哈佛大学布列根和妇女医院授课(Schuster Distinguished Lectureship),2020年在日本呼吸器外科学会(JACS)第37届年会特邀授课。2017年起应邀为The Journal of Thoracic and Cardiovascular Surgery撰写评论文章11篇。相关成果累计在Journal of Clinical OncologyCancer CellJournal of Thoracic OncologyChestAnnals of SurgeryThe Journal of Thoracic and Cardiovascular Surgery等国际权威期刊上发表论文260余篇,其中7篇为基本科学指标数据库(Essential Science Indicators,ESI)高被引论文,33篇论文共41次写入17项肺癌诊治国际指南和分子检测国际指南。建立的治疗方案使肺癌患者术后5年生存率超越国际水平10%,被国际专家誉为“肺癌外科个体化治疗向前迈进的重要一步”和“精准医学时代的精准外科”,树立了国际胸部肿瘤外科诊治的新标杆,在国际上得到广泛推广和应用。

Important progress in surgical treatment of lung cancer in 2023

QIAN Bin1,2(), CHEN Haiquan1,3()   

  1. 1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
    2. Department of Thoracic Surgery, Jiangdu People’s Hospital of Yangzhou City, Yangzhou 225000, Jiangsu Province, China
    3. Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
  • Received:2024-03-28 Revised:2024-04-28 Published:2024-04-30 Online:2024-05-17
  • Contact: CHEN Haiquan

摘要:

肺癌是中国发病率和死亡率最高的恶性肿瘤,外科手术是肺癌治疗的重要手段。2023年,肺癌外科治疗领域取得了多项重要进展。首先是CALGB140503研究结果公布,该研究表明,对于周围型≤2 cm小结节肺癌,亚肺叶切除与肺叶切除术在生存率上差异无统计学意义,为确立亚肺叶切除术在早期肺癌治疗中的地位奠定了基础。其次,JCOG1211研究发现肺段切除术可以用于治疗2 ~ 3 cm磨玻璃结节为主的肺腺癌,但是该研究存在过度治疗现象,通过术中快速冷冻切片病理学检查可能降低过度治疗的风险。ECTOP-1003研究提出了基于肿瘤部位和术中快速冷冻切片病理学检查的选择性淋巴结清扫策略,准确率达100%,为淋巴结清扫提供了更加精准的方案。此外,对于肺腺癌治愈窗口期的探索成果也引人瞩目,即在早期肺癌治疗中,需要把握手术治愈的时间窗,避免过度治疗。最后,ECTOP-1008研究结果显示,高分辨率胸部CT有助于判断肺癌的病理浸润程度,有助于治愈窗口期的精准判断。本文对2023年度肺癌外科治疗领域的重要研究进展予以回顾,以期为肺癌外科治疗的临床实践及未来的临床研究提供思路。

关键词: 肺癌, 研究进展, 亚肺叶切除, 治愈窗口期

Abstract:

Lung cancer is the malignant tumor with the highest incidence and mortality rate in China, and surgical resection is a crucial approach for its treatment. In 2023, significant advancements were made in the field of lung cancer surgery. Firstly, CALGB140503 showed that for peripheral ≤2 cm nodular lung cancer, sublobar resection demonstrated no significant difference in survival rates compared to lobectomy, establishing the foundation for its role in early lung cancer treatment. Secondly, JCOG1211 found that segmentectomy could be used to treat 2-3 cm ground-glass opacity-predominant adenocarcinoma, however, patient in this study may undergo overtreatment, which could potentially be mitigated through intraoperative rapid frozen section pathological examination. Furthermore, the ECTOP-1003 study proposed a selective lymph node dissection strategy based on tumor location and intraoperative rapid frozen section pathological examination, achieving a 100% accuracy rate and providing a more precise approach to lymph node dissection. Additionally, the exploration of the cure time window for lung adenocarcinoma was remarkable, emphasizing the importance of timing in surgical intervention to avoid overtreatment in early lung cancer treatment. Finally, the ECTOP-1008 study demonstrated that high-resolution chest computed tomography (CT) scans assisted in determining the pathological invasion degree of lung cancer, aiding in the precise judgment of curative time window. This review summarized the important research progress in the field of lung cancer surgery in 2023, aiming to provide insights for clinical practice and future trials in lung cancer surgery.

Key words: Lung cancer, Research progress, Sublobar resection, Cure time window

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