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SCI 5 April 2024
Omitting lymph node dissection for small ground glass opacity-dominant tumors (The Annals of Thoracic Surgery, IF: 4.60) Takahiro Mimae, MD PhD, Yoshihiro Miyata, MD PhD, Norifumi Tsubokawa, MD PhD, Yujin Kudo, MD PhD, Takuya Nagashima, MD PhD, Hiroyuki Ito, MD PhD, Norihiko Ikeda, MD PhD, Morihito Okada, MD PhD CORRESPONDENCE TO: morihito1217@ hiroshima-u.ac.jp
BACKGROUND 背景The study purpose 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. 本研究旨在确定在肺癌患者中需要进行淋巴结清扫的最佳范围，这些患者罹患放射学上以磨玻璃影为主的位于外周的小的（≤ 3 cm）非小细胞肺癌。
METHODS 方法We analyzed the clinicopathological findings/surgical outcomes of 988 patients with radiological, 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 for 54.5 months (median). Kaplan–Meier curves and log-rank test were used in statistical analyses of the prognosis. 我们分析了在2010年至2020年间接受完整原发肿瘤切除的988例放射学上以磨玻璃影为主、无淋巴结侵犯的非小细胞肺癌患者的临床病理结果/手术结果。患者的随访时间为54.5个月（中位数）。我们在预后统计分析中使用Kaplan-Meier曲线和log-rank检验。
RESULTS 结果Median age, whole tumor size, solid tumor size, and maximum standardized uptake value were 68 years, 1.7 cm, 0.4 cm, and 0.9, respectively. Sixty percent of the cohort were females (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 adenocarcinoma. One patient had hilar lymph node involvement; however, no mediastinal lymph node metastasis or hilar or mediastinal lymph node recurrence was detected. Five-year overall survival rate was 96.5% (95% confidence interval (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%]; lobectomy, 97.1% [95% CI: 94.4 – 98.5%]). 中位年龄、肿瘤大小、肿瘤实性成分大小和最大标准摄取值分别为68岁、1.7 cm、0.4 cm和0.9。该队列中60%为女性（n = 590）。分别有206例、372例和410例患者进行楔形切除、肺段切除和肺叶切除。在988例肿瘤中的982例（99%）为腺癌。有1例患者肺门淋巴结有转移；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%置信区间（CI）：94.8 – 97.7%）。不论采用哪种手术方式（楔形切除，94.7% [95% CI: 89.1 – 97.5%]；肺段切除，96.9% [95% CI: 93.7 – 98.5%]；肺叶切除，97.1% [95% CI: 94.4 – 98.5%]），均取得了优异的生存结果。
CONCLUSIONS 结论Omitting lymph node dissection may be acceptable with curative intent for small tumors with radiological 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. 对于放射学上以磨玻璃为主的小肿瘤，可接受根治性淋巴结清扫。如果能够确保手术切缘阴性，适当的手术方式如楔形切除、肺段切除或肺叶切除可以在患有惰性肿瘤的患者中提供令人满意的结果。
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