Over- and under-treatment of lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Junjie ¹ , YE Ting ² , ZHANG Yang ² ,  CHEN Haiquan ²

1. Department of Thoracic Surgery, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Liaocheng, 252600, Shandong, P.R.China;
2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Institute of Thoracic Cancer of Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

CHEN Haiquan, Email: hqchen1@yahoo.com

Keywords：

Lung cancer; ground-glass nodule; surgical treatment

DOI：

10.7507/1007-4848.202101097

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

With the development and improved availability of low-dose computed tomography (LDCT), an increasing number of patients are clinically diagnosed with lung cancer manifesting as ground-glass nodules. Although radical surgery is currently the mainstay of treatment for patients with early-stage lung cancer, traditional anatomic lobectomy and mediastinal lymph node dissection (MLND) are not ideal for every patient. Clinically, it is critical to adopt an appropriate approach to pulmonary lobectomy, determine whether it is necessary to perform MLND, establish standard criteria to define the scope of lymph node dissection, and optimize the decision-making process. Thereby avoiding over- and under-treatment of lung cancer with surgical intervention and achieving optimal results from clinical diagnosis and treatment are important issues before us.

Citation： MA Junjie, YE Ting, ZHANG Yang, CHEN Haiquan. Over- and under-treatment of lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 753-756. doi: 10.7507/1007-4848.202101097 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Gao S, Li N, Wang S, et al. Lung cancer in People's Republic of China. J Thorac Oncol, 2020, 15(10): 1567-1576.
3.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
4.	Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
5.	Naruke T, Suemasu K, Ishikawa S. Surgical treatment for lung cancer with metastasis to mediastinal lymph nodes. J Thorac Cardiovasc Surg, 1976, 71(2): 279-285.
6.	Naruke T, Goya T, Tsuchiya R, et al. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg, 1988, 46(6): 603-610.
7.	中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2019 版). 中华肿瘤杂志, 2020, 42(4): 257-287.
8.	Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized confirmatory phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). 2017 ASCO Annual Meeting Abstract No: 8561. J Clin Oncol, 2017, 35(Suppl 15): 8561.
9.	Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: Results of a prospective randomized trial. Ann Surg, 1998, 227(1): 138-144.
10.	Han H, Zhao Y, Chen H. Selective versus systematic lymph node dissection (other than sampling) for clinical N2-negative non-small cell lung cancer: A meta-analysis of observational studies. J Thorac Dis, 2018, 10(6): 3428-3435.
11.	Maglioco A, Machuca D, Mundiñano J, et al. Lymphadenectomy exacerbates tumor growth while lymphadenectomy plus the adoptive transfer of autologous cytotoxic cells and low-dose cyclophosphamide induces regression of an established murine fibrosarcoma. Cancer Immunol Immunother, 2011, 60(3): 389-399.
12.	叶鑫, 崔松平, 刘毅, 等. 直径小于2 cm 周围型非小细胞肺癌淋巴结转移规律研究及淋巴结清扫方式探讨. 中华胸心血管外科杂志, 2020, 36(9): 513-517.
13.	Chida M, Minowa M, Karube Y, et al. Worsened long-term outcomes and postoperative complications in octogenarians with lung cancer following mediastinal lymph-node dissection. Interact Cardiovasc Thorac Surg, 2009, 8(1): 89-92.
14.	Zhang Y, Sun Y, Xiang J, et al. A prediction model for N2 disease in T1 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 144(6): 1360-1364.
15.	Deng HY, Qin CL, Li G, et al. Can lobe-specific lymph node dissection be an alternative to systematic lymph node dissection in treating early-stage non-small cell lung cancer: A comprehensive systematic review and meta-analysis? J Thorac Dis, 2018, 10(5): 2857-2865.
16.	Wang Z, Qi Z, Cheng D, et al. Lobe-specific node dissection can be a suitable alternative to systematic lymph node dissection in highly selective early-stage non-small-cell lung cancer patients: A meta-analysis. Ann Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
17.	Darling GE. Current status of mediastinal lymph node dissection versus sampling in non-small cell lung cancer. Thorac Surg Clin, 2013, 23(3): 349-356.
18.	Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: Results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol, 2011, 6(8): 1367-1372.
19.	Flores RM, Nicastri D, Bauer T, et al. Computed tomography screening for lung cancer: Mediastinal lymph node resection in stage ⅠA nonsmall cell lung cancer manifesting as subsolid and solid nodules. Ann Surg, 2017, 265(5): 1025-1033.
20.	Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
21.	Meng S, Liu G, Wang S, et al. Nodal involvement pattern in clinical stage ⅠA non-small cell lung cancer according to tumor location. Cancer Manag Res, 2020, 12: 7875-7880.
22.	Cheng X, Zheng D, Li Y, et al. Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2018, 155(6): 2648-2656.
23.	Zhang Y, Fu F, Wen Z, et al. Segment location and ground glass opacity ratio reliably predict node-negative status in lung cancer. Ann Thorac Surg, 2020, 109(4): 1061-1068.
24.	Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage Ⅰ and Ⅱ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
25.	Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: A propensity score matching study. J Thorac Oncol, 2017, 12(1): 85-93.
26.	Zhang Y, Sun Y, Shen L, et al. Predictive factors of lymph node status in small peripheral non-small cell lung cancers: Tumor histology is more reliable. Ann Surg Oncol, 2013, 20(6): 1949-1954.
27.	Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
28.	Cheng X, Onaitis MW, D'amico TA, et al. Minimally invasive thoracic surgery 3.0: Lessons learned from the history of lung cancer surgery. Ann Surg, 2018, 267(1): 37-38.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Gao S, Li N, Wang S, et al. Lung cancer in People's Republic of China. J Thorac Oncol, 2020, 15(10): 1567-1576.
3. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
4. Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
5. Naruke T, Suemasu K, Ishikawa S. Surgical treatment for lung cancer with metastasis to mediastinal lymph nodes. J Thorac Cardiovasc Surg, 1976, 71(2): 279-285.
6. Naruke T, Goya T, Tsuchiya R, et al. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg, 1988, 46(6): 603-610.
7. 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2019 版). 中华肿瘤杂志, 2020, 42(4): 257-287.
8. Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized confirmatory phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). 2017 ASCO Annual Meeting Abstract No: 8561. J Clin Oncol, 2017, 35(Suppl 15): 8561.
9. Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: Results of a prospective randomized trial. Ann Surg, 1998, 227(1): 138-144.
10. Han H, Zhao Y, Chen H. Selective versus systematic lymph node dissection (other than sampling) for clinical N2-negative non-small cell lung cancer: A meta-analysis of observational studies. J Thorac Dis, 2018, 10(6): 3428-3435.
11. Maglioco A, Machuca D, Mundiñano J, et al. Lymphadenectomy exacerbates tumor growth while lymphadenectomy plus the adoptive transfer of autologous cytotoxic cells and low-dose cyclophosphamide induces regression of an established murine fibrosarcoma. Cancer Immunol Immunother, 2011, 60(3): 389-399.
12. 叶鑫, 崔松平, 刘毅, 等. 直径小于2 cm 周围型非小细胞肺癌淋巴结转移规律研究及淋巴结清扫方式探讨. 中华胸心血管外科杂志, 2020, 36(9): 513-517.
13. Chida M, Minowa M, Karube Y, et al. Worsened long-term outcomes and postoperative complications in octogenarians with lung cancer following mediastinal lymph-node dissection. Interact Cardiovasc Thorac Surg, 2009, 8(1): 89-92.
14. Zhang Y, Sun Y, Xiang J, et al. A prediction model for N2 disease in T1 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 144(6): 1360-1364.
15. Deng HY, Qin CL, Li G, et al. Can lobe-specific lymph node dissection be an alternative to systematic lymph node dissection in treating early-stage non-small cell lung cancer: A comprehensive systematic review and meta-analysis? J Thorac Dis, 2018, 10(5): 2857-2865.
16. Wang Z, Qi Z, Cheng D, et al. Lobe-specific node dissection can be a suitable alternative to systematic lymph node dissection in highly selective early-stage non-small-cell lung cancer patients: A meta-analysis. Ann Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
17. Darling GE. Current status of mediastinal lymph node dissection versus sampling in non-small cell lung cancer. Thorac Surg Clin, 2013, 23(3): 349-356.
18. Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: Results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol, 2011, 6(8): 1367-1372.
19. Flores RM, Nicastri D, Bauer T, et al. Computed tomography screening for lung cancer: Mediastinal lymph node resection in stage ⅠA nonsmall cell lung cancer manifesting as subsolid and solid nodules. Ann Surg, 2017, 265(5): 1025-1033.
20. Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
21. Meng S, Liu G, Wang S, et al. Nodal involvement pattern in clinical stage ⅠA non-small cell lung cancer according to tumor location. Cancer Manag Res, 2020, 12: 7875-7880.
22. Cheng X, Zheng D, Li Y, et al. Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2018, 155(6): 2648-2656.
23. Zhang Y, Fu F, Wen Z, et al. Segment location and ground glass opacity ratio reliably predict node-negative status in lung cancer. Ann Thorac Surg, 2020, 109(4): 1061-1068.
24. Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage Ⅰ and Ⅱ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
25. Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: A propensity score matching study. J Thorac Oncol, 2017, 12(1): 85-93.
26. Zhang Y, Sun Y, Shen L, et al. Predictive factors of lymph node status in small peripheral non-small cell lung cancers: Tumor histology is more reliable. Ann Surg Oncol, 2013, 20(6): 1949-1954.
27. Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
28. Cheng X, Onaitis MW, D'amico TA, et al. Minimally invasive thoracic surgery 3.0: Lessons learned from the history of lung cancer surgery. Ann Surg, 2018, 267(1): 37-38.

Next Article
Efficacy and safety of transapical transcatheter aortic valve replacement in the treatment of aortic regurgitation in patients with large aortic annulus

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Over- and under-treatment of lung cancer

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content