Prognostic significance of lymph node dissection for lung cancer surgery: a narrative review.
Prognostic significance of lymph node dissection for lung cancer surgery: a narrative review.
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DOI：
10.21037/jtd-22-1527
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发表时间：
2023-04-28
影响因子：
2.5
通讯作者：
Ishida, Hironori
中科院分区：
文献类型：
--
作者：
Ichiki, Yoshinobu;Taguchi, Ryo;Yanagihara, Akitoshi;Umesaki, Tetsuya;Nitanda, Hiroyuki;Sakaguchi, Hirozo;Ishida, Hironori
关键词：
理论上，肺癌手术中的系统性淋巴结清扫（SLND）是一种留下较少癌细胞的技术，据推测可以改善预后，但其预后意义仍存在争议。此外，随着周围型小尺寸肺癌有限手术的出现和免疫检查抑制剂（ICI）的出现，围绕淋巴结清扫的社会环境也发生了变化。因此，我们重新考虑淋巴结清扫的作用。通过参考以往的报道，我们回顾了SLND在肺癌手术中的建立过程。我们比较了肺癌手术中 SLND 和淋巴结取样 (LNS) 的五项随机前瞻性比较研究。在五项随机前瞻性比较研究中，两项报告称 SLND 的总生存期 (OS) 有所改善，但其余三项报告称 SLND 和 LNS 之间的 OS 没有显着差异。五份报告中有一份显示 SLND 并发症显着增加。对于肿瘤直径≤2 cm且实变与肿瘤比率>0.5的周围型非小细胞肺癌（NSCLC）病例，与肺叶切除术相比，肺段切除术可显着提高 OS 风险比。然而，各组中 SLND 和肺叶特异性淋巴结清扫术 (L-SLND) 的比例似乎尚不清楚。在肺段切除术中，节间淋巴结的清扫往往比较宽松，因此有必要探讨淋巴结清扫在肺段切除术中的意义。 ICI 已经显示出优异的效果，并且可能有必要检查去除癌症特异性细胞毒性 T 淋巴细胞 (CTL) 集中的区域淋巴结后对 ICI 有何影响。 SLND 对于准确分期至关重要，但理想情况下（在淋巴结中没有癌细胞的宿主或癌细胞对 ICI 高度敏感的宿主中）最好离开区域淋巴结。 SLND 可能并非在所有情况下都是正确的选择。也许有一天，淋巴结清扫的范围会针对每个病例单独确定。等待未来的验证结果。
Theoretically, systematic lymph node dissection (SLND) in lung cancer surgery is a technique that leaves less cancer cells behind and is speculated to improve the prognosis, but its prognostic significance still remains controversial. In addition, the social environment surrounding lymph node dissection has changed with the advent of limited surgery for peripheral small-sized lung cancer and emergence of immune check inhibitor (ICI). Therefore, we reconsidered the role of lymph node dissection. By referring to past reports, we reviewed the process leading up to the establishment of SLND in lung cancer surgery. We compared five randomized prospective comparative studies on SLND and lymph node sampling (LNS) in lung cancer surgery. Of the five randomized prospective comparative studies, two reported an improvement in overall survival (OS) with SLND, but the remaining three reported no significant difference in OS between SLND and LNS. One out of the five reports revealed a significant increase in complications with SLND. For peripheral non-small cell lung cancer (NSCLC) cases with tumor diameter ≤2 cm and consolidation-to-tumor ratio >0.5 segmentectomy was found to significantly improve the hazard ratio of OS, when compared to a lobectomy. However, the proportion of SLND and lobe-specific lymph node dissection (L-SLND) in each group seems to be unclear. In segmentectomy, the dissection of intersegmental lymph nodes tends to be lenient, and therefore it seems necessary to examine the significance of lymph node dissection in segmentectomy. ICIs are already showing excellent effects, and it may be necessary to examine how they will be affected by removal of regional lymph nodes where cancer-specific cytotoxic T lymphocytes (CTLs) are concentrated. SLND is essential for accurate staging, but ideally—in a host with no cancer cells in the lymph node or a host with cancer cells having a high sensitivity to ICI—it might be better to leave the regional lymph node. SLND may not be the right choice in all cases. A time may come when the extent of lymph node dissection is determined individually for each case. Future verification results are awaited.
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