臨床病期I期肺癌における至適縮小手術の検討―断端距離/腫瘍径比,断端細胞診の意義(KLSG0801副次解析)

肺癌消極的縮小手術前向き研究(KLSG0801)症例を用いて腫瘍局在(TL)別の腫瘍径(TS)と断端距離(MD)の関係,MD/TSおよび切除断端細胞診(MC)と予後の関係を後ろ向きに検討した.TSとMDの関係はTLがLewis分類Easy(n=18)では正の相関を認めたがDifficult(n=14)では認めず,TSが大きくてもMDは十分確保されていなかった.3生率は,MD/TS>1(n=12)では100%,MD/TS≦1(n=20)では59.7%(p=0.06),MC(-)(n=18)では88.1%,MC(+)(n=5)では20%で,MC(+)は有意に予後不良であった(p=0.001).MC...

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Published in日本呼吸器外科学会雑誌 Vol. 32; no. 4; pp. 450 - 457
Main Authors 高橋, 伸政, 中山, 光男, 澤端, 章好, 星, 永進, 坂口, 浩三, 川村, 雅文, 堀尾, 裕俊, 吉谷, 克雄, 金子, 公一, 松谷, 哲行, 大塚, 崇, 千田, 雅之
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本呼吸器外科学会 15.05.2018
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ISSN0919-0945
1881-4158
DOI10.2995/jacsurg.32.450

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Abstract 肺癌消極的縮小手術前向き研究(KLSG0801)症例を用いて腫瘍局在(TL)別の腫瘍径(TS)と断端距離(MD)の関係,MD/TSおよび切除断端細胞診(MC)と予後の関係を後ろ向きに検討した.TSとMDの関係はTLがLewis分類Easy(n=18)では正の相関を認めたがDifficult(n=14)では認めず,TSが大きくてもMDは十分確保されていなかった.3生率は,MD/TS>1(n=12)では100%,MD/TS≦1(n=20)では59.7%(p=0.06),MC(-)(n=18)では88.1%,MC(+)(n=5)では20%で,MC(+)は有意に予後不良であった(p=0.001).MC,MD/TSは予後規定因子となる可能性がある.MD/TS>1が重要であるが,Lewis分類DifficultではTS以上のMDの確保が困難である可能性がある.
AbstractList 肺癌消極的縮小手術前向き研究(KLSG0801)症例を用いて腫瘍局在(TL)別の腫瘍径(TS)と断端距離(MD)の関係,MD/TSおよび切除断端細胞診(MC)と予後の関係を後ろ向きに検討した.TSとMDの関係はTLがLewis分類Easy(n=18)では正の相関を認めたがDifficult(n=14)では認めず,TSが大きくてもMDは十分確保されていなかった.3生率は,MD/TS>1(n=12)では100%,MD/TS≦1(n=20)では59.7%(p=0.06),MC(-)(n=18)では88.1%,MC(+)(n=5)では20%で,MC(+)は有意に予後不良であった(p=0.001).MC,MD/TSは予後規定因子となる可能性がある.MD/TS>1が重要であるが,Lewis分類DifficultではTS以上のMDの確保が困難である可能性がある.
Author 金子, 公一
中山, 光男
川村, 雅文
坂口, 浩三
星, 永進
澤端, 章好
吉谷, 克雄
松谷, 哲行
大塚, 崇
千田, 雅之
高橋, 伸政
堀尾, 裕俊
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References 2. 高橋伸政, 澤端章好, 川村雅文, 大塚, 崇, 堀尾裕俊, 坂口浩三, 他. 肺葉切除非耐用症例の臨床病期I期非小細胞肺癌に対する縮小手術の多施設前向き研究 (KLSG-0801). 日呼外会誌 2016; 30: 526-33.
6. Sawabata N. Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin? Gen Thorac Cardiovasc Surg 2013; 61: 9-16.
20. Sawabata N, Maeda H, Matsumura A, Ohta M, Okumura M; Thoracic Surgery Study Group of Osaka University. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer. Surg Today 2012; 42: 238-44.
8. Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, et al. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113: 691-700.
16. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006; 24: 4833-9.
5. Goldstein NS, Ferkowicz M, Kestin L, Chmielewski GW, Welsh RJ. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol 2003; 120: 720-4.
21. UMIN Clinical Trials Registry (UMIN-CTR) [Internet]: Tokyo. 2013-University hospital Medical Information Network (UMIN) Center.[cited: 15 July 2017]The prospective observational study of lung wedge resection for cT1a, 1bN0M0 Non-Small Lung Cancer patients. Available from:https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027991.
7. El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg 2006; 82: 408-15.
15. Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys 2015; 93: 989-96.
13. Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for stage I lung cancer. Eur J Surg Oncol 1991; 17: 42-6.
12. Kutschera W. Segment resection for lung cancer. Thorac Cardiovasc Surg 1984; 32: 102-4.
14. Onishi H, Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies. Jpn J Clin Oncol 2013; 43: 345-50.
17. Sawabata N, Karube Y, Umezu H, Tamura M, Seki N, Ishihama H, et al. Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy. Interact Cardiovasc Thorac Surg 2008; 7: 1044-8.
1. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Kuwano H, Okumura M, Amano J, Arai H, et al. Thoracic and cardiovascular surgery in Japan during 2012: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2014; 62: 734-64.
4. Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg 1992; 104: 1679-85.
18. Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, et al. Thoracic Surgery Study Group of Osaka University. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg 2004; 77: 415-20.
19. Mohiuddin K, Haneuse S, Sofer T, Gill R, Jaklitsch MT, Colson YL, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer. J Thorac Cardiovasc Surg 2014; 147: 1169-77.
9. Errett LE, Wilson J, Chiu RC, Munro DD. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg 1985; 90: 656-61.
11. Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg 1987; 44: 340-3.
3. Takahashi N, Sawabata N, Kawamura M, Ohtsuka T, Horio H, Sakaguchi H, et al. Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication. Gen Thorac Cardiovasc Surg 2016; 64: 470-5.
10. Strauss G, Kwiatkoski D, De-Camp M, Godleski J, Swanson S, Richards W, et al. Extent of surgical resection influences survival in stage IA non-small cell lung cancer (NSCLC). Proc ASCO 1998; 17: 462a.
References_xml – reference: 4. Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg 1992; 104: 1679-85.
– reference: 8. Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, et al. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113: 691-700.
– reference: 17. Sawabata N, Karube Y, Umezu H, Tamura M, Seki N, Ishihama H, et al. Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy. Interact Cardiovasc Thorac Surg 2008; 7: 1044-8.
– reference: 1. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Kuwano H, Okumura M, Amano J, Arai H, et al. Thoracic and cardiovascular surgery in Japan during 2012: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2014; 62: 734-64.
– reference: 21. UMIN Clinical Trials Registry (UMIN-CTR) [Internet]: Tokyo. 2013-University hospital Medical Information Network (UMIN) Center.[cited: 15 July 2017]The prospective observational study of lung wedge resection for cT1a, 1bN0M0 Non-Small Lung Cancer patients. Available from:https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027991.
– reference: 15. Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys 2015; 93: 989-96.
– reference: 7. El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg 2006; 82: 408-15.
– reference: 10. Strauss G, Kwiatkoski D, De-Camp M, Godleski J, Swanson S, Richards W, et al. Extent of surgical resection influences survival in stage IA non-small cell lung cancer (NSCLC). Proc ASCO 1998; 17: 462a.
– reference: 6. Sawabata N. Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin? Gen Thorac Cardiovasc Surg 2013; 61: 9-16.
– reference: 13. Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for stage I lung cancer. Eur J Surg Oncol 1991; 17: 42-6.
– reference: 3. Takahashi N, Sawabata N, Kawamura M, Ohtsuka T, Horio H, Sakaguchi H, et al. Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication. Gen Thorac Cardiovasc Surg 2016; 64: 470-5.
– reference: 9. Errett LE, Wilson J, Chiu RC, Munro DD. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg 1985; 90: 656-61.
– reference: 14. Onishi H, Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies. Jpn J Clin Oncol 2013; 43: 345-50.
– reference: 11. Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg 1987; 44: 340-3.
– reference: 18. Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, et al. Thoracic Surgery Study Group of Osaka University. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg 2004; 77: 415-20.
– reference: 20. Sawabata N, Maeda H, Matsumura A, Ohta M, Okumura M; Thoracic Surgery Study Group of Osaka University. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer. Surg Today 2012; 42: 238-44.
– reference: 2. 高橋伸政, 澤端章好, 川村雅文, 大塚, 崇, 堀尾裕俊, 坂口浩三, 他. 肺葉切除非耐用症例の臨床病期I期非小細胞肺癌に対する縮小手術の多施設前向き研究 (KLSG-0801). 日呼外会誌 2016; 30: 526-33.
– reference: 19. Mohiuddin K, Haneuse S, Sofer T, Gill R, Jaklitsch MT, Colson YL, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer. J Thorac Cardiovasc Surg 2014; 147: 1169-77.
– reference: 12. Kutschera W. Segment resection for lung cancer. Thorac Cardiovasc Surg 1984; 32: 102-4.
– reference: 5. Goldstein NS, Ferkowicz M, Kestin L, Chmielewski GW, Welsh RJ. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol 2003; 120: 720-4.
– reference: 16. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006; 24: 4833-9.
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Snippet 肺癌消極的縮小手術前向き研究(KLSG0801)症例を用いて腫瘍局在(TL)別の腫瘍径(TS)と断端距離(MD)の関係,MD/TSおよび切除断端細胞診(MC)と予後の関係を後ろ...
SourceID jstage
SourceType Publisher
StartPage 450
SubjectTerms I期
断端細胞診
断端距離
腫瘍径
非小細胞肺癌
Title 臨床病期I期肺癌における至適縮小手術の検討―断端距離/腫瘍径比,断端細胞診の意義(KLSG0801副次解析)
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