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AATS 2017 | Prof. Benny Weksler: 辅助化疗可提高生存率

Published at: 2015年第1卷第S1期

沈建飞
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编者按:Benny Weksler是胸科肿瘤学教授,外科教授,预防医学教授,田纳西大学健康科学中心、孟菲斯卫理公会医院的胸外科主任(University of Tennessee Health Science Center, Methodist University Hospital)。

第97届美国胸心外科年会(AATS)将于2017年4月29日至5月3日在波士顿举行。Weksler教授作为今年AATS的new member, 也在会上有一篇题为《辅助化疗可改善完全切除的侵犯胸壁T3N0非小细胞肺癌患者的预后》的演讲。AATS会议之前,沈建飞医生针对该话题提出了5个问题,对Weksler教授进行采访,探讨了辅助化疗应用方面的热点话题。

Weksler教授解释道,辅助治疗是手术治疗后接受化疗或放疗。推荐在特定的肺癌患者中使用辅助化疗,因为已在几项临床试验中显示其可以改善总生存期。其团队的研究表明,假设所有T3肿瘤都应接受辅助化疗是合乎逻辑的。

Q1. 本研究证实辅助化疗可改善完全切除的侵犯胸壁T3N0非小细胞肺癌患者的预后,其他T3N0 NSCLC患者可以从辅助化疗中获益吗?

目前的指南推荐IIB期患者接受辅助化疗(T3N0,T1/2N1)。大多数数据源于研究,其中辅助化疗可使N1而非N0患者获益。根据我们的研究,假设所有T3肿瘤都应接受辅助化疗是合乎逻辑的。

Q2. 早期(Ib)NSCLC中化疗的价值?

对于肿瘤小于4cm的患者,很少会推荐化疗。Ib期和肿瘤大于3cm且小于4cm的患者,目前指南推荐辅助治疗。对于IB期和肿瘤大于4cm的患者,几项亚组分析研究显示辅助化疗可使患者获益。T2aN0患者存在低分化,血管受累,内脏胸膜受累,或未接受淋巴结采样(T2aNx)等高危因素时,应考虑辅助治疗。

Q3. 可否解释什么是早期NSCLC辅助化疗,为什么会被推荐?

辅助治疗是手术治疗后接受化疗或放疗。推荐在特点的肺癌患者中使用,因为已在几项临床试验中显示其可以改善总生存期。

Q4. 您是否认为手术切除的较小(≤4cm)且淋巴结阴性的NSCLC肿瘤的患者应接受辅助化疗?

除非这些肿瘤具有高风险特征(如上所述),否则这些患者没有辅助治疗的指征。

Q5. 靶向治疗在手术切除肺癌患者中的作用?

靶向治疗在肺癌治疗领域的研究结果令人振奋。最常见的靶向突变是EGFR突变,但ALK重排,ROS1重排和PDL1表达也很常见。在IV期疾病患者中,靶向治疗已成为第一线治疗。目前没有研究支持靶向治疗用于肺癌辅助治疗。

受访专家:Benny Weksler

Benny Weksler, MBA, MD, FACS

Benny Weksler, MBA, MD, FACS is the Eastridge-Cole Professor of Thoracic Oncology, Professor of Surgery and Preventive Medicine and Chief of Division of Thoracic Surgery at the University of Tennessee Health Science Center, Methodist University Hospital.

Dr. Weksler is an acclaimed Thoracic Surgeon who has special interest in treating thoracic cancers with minimally invasive and robotic techniques. Dr. Weksler is always looking to further his education and use the latest, safest technology and procedures for his patients. Before moving to Memphis, he was the Chief of the Section of Thoracic Surgery in the Pittsburgh VA Health Care System, as well as the Director of Robotic Thoracic Surgery at the University of Pittsburgh Medical Center in Pittsburgh, PA. Currently he is the Chief of the Division of Thoracic Surgery as well as a Professor of Surgery at the University of Tennessee Health Science Center. Dr. Weksler is a guest reviewer for several scholarly journals, and a member of the editorial board of “Innovation”. Dr. Weksler is a member of many Scientific and Professional Societies, most recently serving as the president of the Eastern Cardiothoracic Surgical Society. Castle Connelly has recognized him as part of the top 1% of American surgeons.

AME学术记者:沈建飞

医学博士,浙江省台州医院,住院医师。J Thorac Dis和Ann Transl Med杂志的Section Editor。在JCO、JTCVS、JSO、JTD等学术期刊发表SCI论文25篇,其中第一/共一15篇。

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