Strategic approach to minimally invasive mediastinal nodal staging-a brave new world?
Strategic approach to minimally invasive mediastinal nodal staging-a brave new world?
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微创纵隔淋巴结分期的战略方法——一个美丽的新世界？
DOI：
10.1016/s2213-2600(16)30366-6
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Osarogiagbon,RaymondU
中科院分区：
文献类型：
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作者：
Osarogiagbon,RaymondU
全球每年诊断出患有肺癌的 1·500 万人的总 5 年生存率约为 18%。 1 这些幸存者大多是接受过明确治疗的早期疾病患者，通常是治愈性手术、明确的放射治疗或这些治疗与化疗的组合。对于可能治愈的肺癌患者来说，预后和治疗选择的主要决定因素是纵隔淋巴结的状况。 2 纵隔淋巴结转移的患者通常被分类为化疗和放疗联合治疗，而无纵隔淋巴结转移的患者通常被分类为手术切除。 3, 4 新疗法的临床试验依赖于准确的分期，以平衡预后相似的患者子集的随机分组。肺癌分期的建议与实际实践之间存在广泛而深刻的差距，这种差距对患者的生存有着深远的影响。 5, 6这一差距涵盖了 PET 和 CT 扫描等放射分期方法的使用，通过侵入性分期活检方法的使用，到手术切除时的病理分期。 5, 7 微创纵隔淋巴结分期技术支气管内超声 (EBUS) 和食管超声 (EUS) 可能提供快速、准确、低风险且相对便宜（与外科手术技术相比）的纵隔淋巴结通路。随着非手术治疗选择的迅速扩大，有关纵隔淋巴结状况的信息的价值迅速上升，包括立体定向全身放射作为淋巴结阴性疾病患者的潜在替代方案，以及针对纵隔淋巴结转移患者的联合化疗和放射治疗。但是，将这两种纵隔微创方法部署到战略上最合理的方法是什么？
The aggregate 5 year survival of the 1· 5 million individuals diagnosed annually with lung cancer worldwide is about 18%. 1 These survivors are mostly patients with early-stage disease who have undergone definitive treatment, usually surgery with curative intent, definitive radiation therapy, or combinations of these treatments with chemotherapy. For patients with potentially curable lung cancer, the main determinant of prognosis and treatment selection is the status of mediastinal lymph nodes. 2 Patients with mediastinal nodal metastasis are usually triaged to combined modality chemotherapy and radiation, whereas patients without mediastinal nodal metastasis are usually triaged to surgical resection. 3, 4 Clinical trials of novel treatments rely on accurate staging for balanced randomisation of prognostically similar subsets of patients. There is a broad and deep gap between recommended and actual practice of lung cancer staging, and this gap has a profound effect on patient survival. 5, 6This gap spans the use of radiological staging methods such as PET and CT scans, through the use of invasive staging biopsy methods, to pathological staging at the time of surgical resection. 5, 7 The minimally-invasive mediastinal nodal staging techniques endobronchial ultrasound (EBUS) and oesophageal ultrasound (EUS) potentially provide rapid, accurate, low-risk, and relatively inexpensive (in comparison with surgical techniques) access to mediastinal lymph nodes. The value of this information on the status of mediastinal lymph nodes rises apace, with the rapid expansion of non-surgical options for curative-intent treatment, including stereotactic body radiation as a potential alternative for patients with node-negative disease, and combined modality chemotherapy and radiation therapy for patients with mediastinal nodal metastasis. But what is the most strategically sound way to deploy these two minimally-invasive approaches to the mediastinum?