摘要
随着TNM分期系统不断更新,ⅠB期非小细胞肺癌(NSCLC)的定义和划分也在调整。虽然它是早期肿瘤,但术后复发和转移风险仍偏高,5年生存率依旧是临床上令人担忧的话题。第8版TNM分期将T2b(4 cm<T2b≤5 cm)上调为ⅡA期,突出其预后的不同及术后辅助治疗的重要性,但针对ⅠB期(3 cm<T2a≤4 cm)的辅助化疗一直争议不断,目前多数临床医生的共识是对于ⅠB期术后存在高危险因素的患者,推荐进行多学科综合评估,结合患者意愿后可考虑辅助化疗。近年来靶向治疗已逐渐成为驱动基因阳性非小细胞肺癌的一线治疗手段,ADAURA研究显示奥希替尼对于3 cm<T2≤5 cm的患者有降低术后复发风险的作用,部分指南建议结合基因突变结果和患者意愿后谨慎推荐,靶向治疗能否作为这部分群体的选择仍有待进一步成熟研究结果的支持。新辅助化疗和免疫治疗在ⅠB~ⅢA期NSCLC患者术后取得了不错的主要病理缓解率,有待Ⅲ期随机对照试验(RCT)给ⅠB期患者预后评估方面更多的证据支持。不能手术的ⅠB期NSCLC,立体定向放射治疗和消融治疗也是不错的选择。本文对ⅠB期NSCLC的分期演变及治疗研究进展进行综述,以期一定程度上能为临床工作提供一些依据和参考。
As the TNM staging system continues to update,the definition and classification of stageⅠB non-small cell lung cancer(NSCLC)is also adjusted.Although it is an early-stage tumor,the risk of recurrence and metastasis is still high,and the 5-year overall survival is still a concern.The 8th edition of the TNM staging system raised T2b(4 cm<T2b≤5 cm)to stageⅡA,highlighting the poor prognosis and the importance of adjuvant therapy,but the adjuvant treatment for stage IB(3 cm<T2a≤4 cm)has been controversial.At present,the consensus of most clinicians is recommending a multidisciplinary comprehensive evaluation to patients who have high risk factors after stageⅠB surgery,and adjuvant chemotherapy can be considered based on the patient’s wishes.In recent years,targeted therapy has gradually become the first-line treatment for driver gene-positive NSCLC.The ADAURA trial showed that osimertinib can reduce the risk of postoperative recurrence inⅠB NSCLC(AJCC version 7).Adjuvant chemotherapy or osimertinib can be considered in stageⅠB patients with high risk factors based on multidisciplinary evaluation and patients’will.Good major pathological response(MPR)was achieved in the application of neoadjuvant chemotherapy or neoadjuvant immunotherapy for patients with stageⅠB–ⅢA NSCLC.Further phase 3 RCTs to validate the effect are needed.Stereotactic body radiation therapy or ablation therapy is also a great surrogate for patients with early-stage inoperable NSCLC.In this article,the evolution of stageⅠB NSCLC,current diagnosis and treatment strategies will be reviewed,which will provide some bases and references for our clinical practice.
作者
申磊磊
刘阳
Leilei Shen;Yang Liu(Department of Thoracic Surgery,Hainan Hospital of Chinese PLA General Hospital,Sanya 572000,China;Department of Thoracic Surgery,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华胸部外科电子杂志》
2022年第4期246-254,共9页
CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition
基金
国家自然科学基金(21876205)
海南省自然科学基金青年基金(818QN322)
三亚市高校及医疗机构专项科技计划(2021GXYL44)
关键词
ⅠB期
非小细胞肺癌
辅助化疗
靶向治疗
ⅠB
Non-small cell lung cancer
Adjuvant chemotherapy
Targeted therapy
作者简介
通讯作者:刘阳,Email:sunny301x@sina.com
