《国际医疗首诊病例》黄女士早期肺癌，手术后治愈率大约为70%

咨询日期：2017年 5月 4日

年龄：45岁

性别：女

诊断：T1bN0 IA期低分化肺腺癌，TTF(3+),AE1/AE3(3+),Syn(2+)

病史总结 (根据查阅送来的二十二页病史)：

On 2017/2/16, chest CT scan at 安徽桐城胸科医院 showed a speculated nodule in the right upper lobe.  Further evaluations at the Cancer Hospital of the Chinese Academy of Medical Sciences (CHCAMS) in Beijing (2017/2/21 – 2/24): Chest CT scan showed a 1.9 x 1.8-cm solid nodule with ground-glass borders in the right upper lobe； bronchoscopy showed no endo-bronchial lesion; CT scans of the head and abdomen were unremarkable except multiple cysts in the liver; bone scan showed no bony lesions.

On 2017/2/27, she underwent a thorascopic lobectomy of the right upper lobe at CHCAMS.  Pathologic examination revealed a 2.4 x 1.5 x 1-cm poorly-differentiated adenocarcinoma, 0.5 cm from the pleural surface, with mixed brochioloalveolar, papillary, mucinous and neuroendocrine features. The surgical margins were clear and there was no neurovascular invasion. None of the 17 regional lymph nodes sampled were involved with metastatic disease.  Immunohistochemical staining was notable for TTF(3+), AE1/AE3(3+) and Syn(2+). Therefore, it was staged as a pT1bN0 or stage IA adenocarcinoma of the lung. She is now seeking an opinion concerning adjuvant therapy.

2017年2月16日，安徽桐城胸科医院胸部CT显示右上肺结节。后在中国医学科学院肿瘤医院做进一步检查，胸部CT证实1.9 x 1.8 cm右上肺结节，支气管镜检查未发现支气管内病灶，头和腹部CT只显示肝内多发囊肿，骨扫描正常。

黄女士于2017年2月27日在中国医学科学院肿瘤医院做了右上肺叶切除。病理显示2.4 x 1.5 x 1 cm低分化腺癌，距胸膜表面0.5 cm，手术切缘干净，17个淋巴结均无肿瘤转移。免疫组化显示TTF(3+), AE1/AE3(3+) 和 Syn(2+)。因此，黄女士肺癌的分期为pT1bN0 IA期。

咨询建议：

1.  It is an early-stage non-small cell lung cancer and the cure rate is estimated to be 70% with complete surgical resection alone, although the significance of the mixed histologic features of the tumor is difficult to assess.

2. According to the most recent publication of “Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non–Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update (Published at jco.org on April 24, 2017)”, no adjuvant therapy, including chemotherapy, molecular-targeting therapy or radiation, is recommended for stage I non-small-cell lung cancer after complete resection, as it has not been proven to improve survival.

3. For future reference, analysis of the mutational status of EGFR，ALK and ROS1 of the tumor specimen is recommended if it has not yet been done.

1．这是一个早期肺癌，手术后治愈率大约为70%。

2．根据2017年4月24日最新发表的“美国临床肿瘤学会/Ontario癌症医疗临床指南”，I期肺癌，手术完全切除后，辅助化疗、分子靶向治疗和放疗对生存没有帮助，因此不建议做辅助化疗、分子靶向治疗或放疗。

3．考虑检测EGFR，ALK和ROS1，这对将来如果肺癌复发的治疗有用。

（原创）美国希望之光医疗，欢迎转载，请注明出处。