Endoscopic evaluation of centrally located early squamous cell carcinoma of the lung
Endoscopic evaluation of centrally located early squamous cell carcinoma of the lung
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DOI：
10.1002/1097-0142(20010315)91:6
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发表时间：
2001-03-15
期刊：
影响因子：
6.2
通讯作者：
Kato, H
中科院分区：
文献类型：
--
作者：
Nakamura, H;Kawasaki, N;Kato, H
背景：近年来，保肺治疗已成为早期肺门部肺癌的一种治疗选择。在选择治疗方法时，内镜下评估肿瘤的组织学范围是很重要的。共分析了46例接受手术治疗的内窥镜评估的早期气管支气管树肺癌患者。16例患者进行了初次手术，30例患者在术前激光治疗后进行了手术。内镜下表现分为浅表型、结节型和息肉型。在切除的肺，最大的特纳尺寸，壁浸润的深度，显微镜下的血管和淋巴管浸润的存在，以及转移到解剖的淋巴结进行了检查。结节组的平均最大肿瘤尺寸为14.6 ± 7.3 mm（平均值±标准差），浅表组为23.3 ± 12.8 mm，息肉组为19.0 ± 9.2 mm。浅表组肿瘤最大直径明显大于结节组（P < 0.01）。46例中34例（74.0%）术前内镜诊断为早期肺门部肺癌。肺门淋巴结转移（N1），支气管外侵犯，并扩展到周围支气管12例。在8名患者中证实了由于术前激光治疗导致的肿瘤完全消失。肿瘤最大直径< 8 mm者无淋巴结转移。5年绝对生存率为76.0%，单纯手术组为87.1%，术前激光治疗后手术组为70.0%。当肿瘤小于或等于8 mm且病变未扩展至外周支气管时，单独使用光动力疗法可治愈早期肺门肺癌。Cancer 2001;91：1142-7. (C)2001年美国癌症协会。
BACKGROUND, Lung-sparing treatment recently has become a choice in the treatment of patients with early hilar lung carcinoma. To select the method of treat ment, it is important to evaluate the histologic extent of the tumor using endoscopy.METHODS. A total of 46 patients who underwent surgery for an endoscopically evaluated early lung carcinoma of the tracheobronchial tree were analyzed. Initial surgery was performed in 16 patients and in 30 patients surgery was performed after preoperative laser therapy. The endoscopic findings were classified into three types: superficial, nodular, and polypoid. In the resected lung, the greatest turner dimension, the depth of mural invasion, the presence of microscopic blood and lymph vessel invasion, and metastases to the dissected lymph nodes were examined.RESULTS. The mean greatest tumor dimensions were 14.6 +/- 7.3 mm (mean +/- standard deviation) in the nodular group, 23.3 +/- 12.8 mm in the superficial group, and 19.0 +/- 9.2 mm in the polypoid group. The greatest tumor dimension in the superficial group was significantly larger than that in the nodular group (P < 0.01]. Preoperative endoscopic diagnosis of early hilar lung carcinoma was correct histologically in 34 of 46 cases (74.0%). Hilar lymph node metastases (N1), extrabronchial invasion, and extension to the peripheral bronchus were recognized in 12 cases. Complete disappearance of the tumor due to preoperative laser therapy was confirmed in eight patients. Lymph node metastasis was not found when the greatest tumor dimension measured < 8 mm. The overall absolute 5-year survival rate was 76.0% for all patients, 87.1% for the surgery alone group, and 70.0% for the surgery after preoperative laser therapy group.CONCLUSIONS. Curative treatment of early hilar lung carcinoma is possible using photodynamic therapy alone when the tumor size is less than or equal to 8 mm and the lesion does not extend to the peripheral bronchus. Cancer 2001;91:1142-7. (C) 2001 American Cancer Society.