文章：

肺癌中的不确定切除：国际肺癌研究协会分类的全面综述

Uncertain Resection in Lung Cancer: A Comprehensive Review of the International Association for the Study of Lung Cancer Classification

原文发布日期：22 April 2025

DOI: 10.3390/cancers17091386

类型: Article

开放获取: 是

英文摘要：

Objective: We explored the impact of uncertain resection in lung cancer on overall survival and disease-free survival.Methods: We performed an exhaustive literature review of all studies comparing prognosis after resection according to the IASLC classification, from the PubMed, Cochrane, MEDLINE, and Google Scholar databases.Results: Overall, 68 original studies were included, of which 67 were retrospective and 1 was prospective, with 81 785 patients included over 46 years. R(un) reclassification was mostly caused by a lack of hilar or mediastinal node dissection, or because of metastasis in the highest node. R(un) is a strong factor for higher recurrence and mortality, while its effects seem limited in early stages. Carcinoma in situ at bronchial margin resection (CIS BRM) does not show an effect on survival, while positive pleural cytology (Cy+) and positive highest mediastinal lymph node (HMLN+) appear to be highly predictive of recurrence and death.Discussion: The R(un) classification of the IASLC appears highly relevant, especially in locally advanced stages IIb-IIIA, and helps to discriminate patients with poor prognosis despite being classified as R0 in the UICC classification.Conclusions: The use of this more precise classification would allow for better stratification of recurrence risk and more effective use of adjuvant therapies. Cy+ patients should receive adjuvant chemotherapy, while CIS BRM patients could likely benefit from endoscopic surveillance to detect local recurrences. HMLN+ patients should be considered at high risk of recurrence, and adjuvant radio-chemotherapy should be considered.

摘要翻译： 

目的：本研究旨在探讨肺癌非确定性切除对患者总生存期和无病生存期的影响。方法：我们系统检索了PubMed、Cochrane、MEDLINE和Google Scholar数据库中所有基于国际肺癌研究协会（IASLC）切除分类标准比较预后的研究文献。结果：共纳入68项原始研究，其中67项为回顾性研究，1项为前瞻性研究，涵盖46年间81,785例患者。R(un)再分类主要源于未进行肺门或纵隔淋巴结清扫，或最高位淋巴结存在转移。R(un)是导致复发率和死亡率升高的重要因素，但其在早期阶段的影响似乎有限。支气管切缘原位癌（CIS BRM）对生存率未见显著影响，而胸腔积液细胞学阳性（Cy+）与最高纵隔淋巴结阳性（HMLN+）对复发和死亡具有高度预测价值。讨论：IASLC的R(un)分类标准具有重要临床意义，尤其在局部晚期（IIb-IIIA期）阶段，有助于甄别虽按国际抗癌联盟（UICC）标准划分为R0切除但预后不良的患者群体。结论：采用此更精确的分类标准可实现更准确的复发风险分层，并提高辅助治疗的应用效能。Cy+患者应接受辅助化疗，CIS BRM患者可能受益于内镜监测以早期发现局部复发，HMLN+患者应被视为高复发风险人群，需考虑辅助放化疗联合治疗方案。

原文链接：

Uncertain Resection in Lung Cancer: A Comprehensive Review of the International Association for the Study of Lung Cancer Classification