Early stage non-small cell lung cancer— the era of preventing "over-diagnosis and over-treatment"_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Keneng

Department of Thoracic Surgery of Beijing Cancer Hospital, Peking University, Beijing, 100142, P.R.China;

Corresponding author：

CHEN Keneng, Email: chenkeneng@bjmu.edu.cn

Keywords：

Early-stage non-small cell lung cancer; ground glass nodule; over-stage; over-staging; over-treatment

DOI：

10.7507/1007-4848.202108076

Video：

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Recent research data showed the concept that "surgery is still the main treatment for early non-small cell lung cancer (NSCLC)" now has new connotation: (1) Pure ground glass nodule (GGO) like lung adenocarcinoma should be regarded as a new clinical issue compared to solid tumors to avoid over-treatment. (2) The deep meaning of multidisciplinary pathological classification of lung adenocarcinoma should be fully understood to avoid over-diagnosis. (3) The T staging of lung adenocarcinoma mixed with GGO components should be correctly understood to avoid over-staging. (4) We should carefully understand the new data of relationship between lung resection extent and prognosis to avoid excessive resection. (5) Attention should be paid to the research progress of minimal residual disease (MRD) to avoid possible insufficient treatment.

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2.	Chen KN. The diagnosis and treatment of lung cancer presented as ground-glass nodule. Gen Thorac Cardiovasc Surg, 2020, 68(7): 697-702.
3.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
4.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
5.	Chen KN. Commentary: Exquisite surgical techniques and comprehensive oncological theory are two fundamental requirement of learning lung cancer surgery. JTCVS technique, 2021: Accepted.
6.	Suzuki K, Koike T, Asakawa T, et al. Japan Lung Cancer Surgical Study Group (JCOG LCSSG). A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
7.	Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)30054-4.
8.	Hattori A, Matsunaga T, Takamochi K, et al. Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2017, 154(6): 2102-2110.
9.	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.
10.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33043-9.
11.	Miyoshi T, Aokage K, Wakabayashi M, et al. Prospective evaluation of watchful waiting for early-stage lung cancer with ground-glass opacity: A single-arm confirmatory multicenter study: Japan Clinical Oncology Group study JCOG1906 (EVERGREEN study). Jpn J Clin Oncol. 2021, hyab074. doi: 10.1093/jjco/hyab074.
12.	Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). 101st AATS conference. Oral presentation.
13.	Shimoyama R, Tsutani Y, Wakabayashi M, et al. A multi-institutional randomized phase Ⅲ trial comparing anatomical segmentectomy and wedge resection for clinical stage ⅠA non-small cell lung cancer in high-risk operable patients: Japan Clinical Oncology Group Study JCOG1909 (ANSWER study). Jpn J Clin Oncol, 2020, 50(10): 1209-1213.
14.	Chae YK, Oh MS. Detection of minimal residual disease using ctDNA in lung cancer: Current evidence and future directions. J Thorac Oncol, 2019, 14(1): 16-24.
15.	Newman AM, Bratman SV, To J, et al. An ultrasensitive method for quantitating circulating tumor DNA with broad patient coverage. Nat Med, 2014, 20(5): 548-554.

1. Detterbeck FC, Boff DJ, Kim AW, et al. The eighth edition lung cancer stage classification. Chest, 2017, 151: 193-203.
2. Chen KN. The diagnosis and treatment of lung cancer presented as ground-glass nodule. Gen Thorac Cardiovasc Surg, 2020, 68(7): 697-702.
3. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
4. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
5. Chen KN. Commentary: Exquisite surgical techniques and comprehensive oncological theory are two fundamental requirement of learning lung cancer surgery. JTCVS technique, 2021: Accepted.
6. Suzuki K, Koike T, Asakawa T, et al. Japan Lung Cancer Surgical Study Group (JCOG LCSSG). A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
7. Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)30054-4.
8. Hattori A, Matsunaga T, Takamochi K, et al. Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2017, 154(6): 2102-2110.
9. 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.
10. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33043-9.
11. Miyoshi T, Aokage K, Wakabayashi M, et al. Prospective evaluation of watchful waiting for early-stage lung cancer with ground-glass opacity: A single-arm confirmatory multicenter study: Japan Clinical Oncology Group study JCOG1906 (EVERGREEN study). Jpn J Clin Oncol. 2021, hyab074. doi: 10.1093/jjco/hyab074.
12. Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). 101st AATS conference. Oral presentation.
13. Shimoyama R, Tsutani Y, Wakabayashi M, et al. A multi-institutional randomized phase Ⅲ trial comparing anatomical segmentectomy and wedge resection for clinical stage ⅠA non-small cell lung cancer in high-risk operable patients: Japan Clinical Oncology Group Study JCOG1909 (ANSWER study). Jpn J Clin Oncol, 2020, 50(10): 1209-1213.
14. Chae YK, Oh MS. Detection of minimal residual disease using ctDNA in lung cancer: Current evidence and future directions. J Thorac Oncol, 2019, 14(1): 16-24.
15. Newman AM, Bratman SV, To J, et al. An ultrasensitive method for quantitating circulating tumor DNA with broad patient coverage. Nat Med, 2014, 20(5): 548-554.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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