恶性局灶性磨玻璃样肺结节的外科治疗

目的 探讨恶性局灶性磨玻璃样肺结节(fGGON)的临床病理特征和手术预后。方法 回顾性总结3年内连续手术切除的96例恶性fGGON患者的临床资料、影像学特点和病理学特征。根据术前影像学显示的磨玻璃样成分(GGO)所占病灶比例分为纯、高、低GGO组，比较各组术后预后。结果 本组病例中大多恶性fGGON为早期肺腺癌。术前影像学显示，GGO所占病灶中比例越高，术后病理呈现单纯型细支气管肺泡细胞癌的成分越多，两者存在相关性(P<0.05)。在纯、高和低GGO病例中，病理检查出现侵袭性表型者分别占0%、28.1%和44.4% (P<0.01)。全组术后3年生存率为100%，纯、高和低GGO组术后3年无瘤生存率分别为100%、90.6%和69.4% (P<0.01)。结论 手术治疗恶性fGGON预后良好，术前病灶中GGO成分比例有助于判断恶性fGGON的病理类型、侵袭性和术后预后。局限性肺切除可能是纯GGO型肺癌更好的手术选择。

Surgical treatment for malignant focal ground glass opacity lung nodule

Objective To identify clinical and pathological characteristics of malignant focal ground glass opacity lung nodule (fGGON) and to select suitable candidates for curative limited resection according to the proportion of GGO. Methods A retrospective analysis of 96 consecutive patients who underwent a complete resection for malignant fGGON was performed during the past three years. All patients were classified as three groups according to the proportion of GGO showed on preoperative CT. The pathological type and prognosis were compared among those groups. The relationships between invasive pathological type and other clinical factors were also assessed. Results Most of malignant fGGON was adenocarcinoma in early stage. With the increase of GGO component in lung cancer, the proportion of simple bronchioloalveolar cell carcinoma (BAC) also increased (P<0.05). There was no invasive pathological type in patients with pure GGO component, but 28.1% and 44.4% were found to have invasive pathological character in those with high GGO component and low component respectively (P<0.01).The overall 3-year survival rate was 100% in general. The 3-year tumor-free survival rate was 100% for patients with pure GGO component, whereas it was 90.6% for those with high GGO component and 69.4% with low GGO component (P<0.01). Conclusion The prognosis after operation for malignant fGGON was excellent. The index of GGO component has significant correlations with histological classification, pathologic invasiveness, and postoperative outcome of malignant fGGON. Patients with tumors that have pure GGO component are considered to be possible candidates for limited pulmonary resection.