肿瘤实性成分占比在早期周围型肺癌诊疗中的研究进展

Research Progress in the Effect of Consolidation Tumor Ratio on the Diagnosis and Treatment of Early-stage Peripheral Lung Cancer

肿瘤实性成分占比(consolidation tumor ratio,CTR)是近年来肺癌影像学研究的热点,是指在高分辨计算机断层扫描(high resolution computed tomography,HRCT)扫描肺窗中肿瘤最大实性直径与肿瘤最大直径的比值。目前诸多研究也证实其可作为早期肺癌良恶性判断指标及亚肺叶切除的主要参考指标,是早期肺癌复发及预后的独立相关因素。尤其在日本JCOG0804和JCOG0802两个基于肿瘤大小和实性成分占比的研究结果相继公布后,早期肺癌的传统外科手术方式被彻底打破,为早期肺癌患者带来了良好获益。但目前对CTR值的研究数据仍有限,CTR值的测定尚缺少客观的评价系统。本文就CTR值在肺结节良恶性预测、外科手术方式选择、淋巴结清扫、气腔播散(spread through air spaces,STAS)等热点研究方面的进展进行综述,同时进一步探讨CTR值可能存在的疗效预测指标,并对早期周围型肺癌外科治疗的发展趋势以及存在的问题进行总结和分析,为临床工作提供新思路。

Consolidation tumor ratio(CTR)is a hot issue in lung cancer imaging studies in recent years.It is defined as the proportion of the maximum consolidation diameter divided by the maximum tumor diameter in the lung window scanned by high resolution computed tomography(HRCT).Many studies have also confirmed that it can be used as an indicator to identify whether a lung tumor is benign or malignant at the early stage,the main basis on which to decide whether sublobectomy can be performed,and is an independent factor for the recurrence and prognosis of early-stage lung cancer.Especially after tumor size and CTR results of JCOG0804 and JCOG0802 trials in Japan were published,a breakthrough in the treatment method upends the conventional surgical approach,which benefits patients with early-stage lung cancer.But insufficient research data on CTR leads to the fact that an evaluation system to measure CTR is yet to be built.This paper discusses the research progress in CTR prediction of benign or malignancy of pulmonary nodules,how to choose a surgical approach,lymph node dissection,spread through air spaces(STAS)and other hot issues.It also investigates the possible indicators to predict efficacy based on CTR,summarizes and analyzes the development trend of surgical methods to treat early-stage peripheral lung cancer and challenges,to provide new ideas for clinical application.