Early lung cancer is a relatively general term. For ordinary people without basic medical knowledge, it is relatively easy to distinguish and judge the severity of early, middle and late stage. In fact, according to the latest version of TNM staging, early stage specifically refers to stage 0 (carcinoma in situ), stage IA and stage IB.
With the popularization of physical examination and the large-scale screening of chest CT, the proportion of early-stage lung cancer has increased significantly in recent years, especially for young women, the number of operations for ground glass nodules has increased year by year . These patients are generally at an early stage. What to do after radical surgery? Do you need to do other treatments accordingly? This is also an issue that everyone is more concerned about. Today, I will explain it in detail according to the different stages.
1.0 issue
Stage 0 refers to carcinoma in situ, including adenocarcinoma in situ and squamous cell carcinoma in situ, with adenocarcinoma in situ being more common. Carcinoma in situ has actually been kicked out of the “cancer” category by WHO and included in the precursor lesion. Carcinoma in situ will not recur and metastasize because the cancer cells have not broken through the basement membrane, and the radical cure rate is 100%. Review every six months to one year after surgery, and no postoperative adjuvant therapy is required.
2.IA period
IA stage is further divided into IA1, IA2, and IA3 according to the size of the primary lesion. Among them, IA1 has a special period of micro-invasive carcinoma. Micro-invasive cancer means that the cancer cells are infiltrated, but the range is not more than 5mm. The radical cure rate of micro-invasive cancer is the same as that of carcinoma in situ, which is 100%. This is confirmed by a large sample study in Japan, and the 10-year survival rate is 100%. Therefore, minimally invasive carcinoma does not require any adjuvant therapy after surgery.
For infiltrative IAIA1, IA2, and IA3 stages, neither the American NCCN guidelines, the European ESMO guidelines nor the Chinese CSCO guidelines recommend adjuvant therapy after surgery, and regular review is recommended. However, clinically, some patients with stage IA3 lung cancer have relatively large primary tumors, close to 3cm, with vascular tumor thrombus, intra-airspace spread, micropapillary or solid components, and relatively high Ki67. The existence of these high-risk factors makes the patients have certain risk of recurrence and metastasis. Therefore, for such patients, if the age is relatively young, the willingness to treat is very strong, and chemotherapy or targeted therapy will be performed after full communication with the patient during clinical operations.
3.IB period
Stage IB is an awkward period, early, but not very early. Even with standard surgery, 20% of patients with stage IB may have subsequent recurrence and metastasis. In 2018, the thoracic surgery team of Fudan University Affiliated Cancer Hospital reported their stage IB data, and the 5-year survival rate was 84.1%. As a top domestic medical team, this data is definitely higher than the domestic average.
Stage IB has a certain probability of recurrence and metastasis, and usually occurs in patients with more high-risk factors, such as those under the age of 45, poorly differentiated, and not undergoing lobectomy , Postoperative pathology showed tumor thrombus in the vessels, involving the visceral pleura, too few lymph nodes detected, close to the incision margin, high expression of Ki67, and the pathological subtype was micropapillary type. Clinically, adjuvant therapy after surgery is generally recommended for these patients. Patients with EGFR gene mutation can consider chemotherapy + targeted therapy maintenance, or direct targeted therapy for 2 to 3 years. For patients with stage IB lung cancer without EGFR mutation and high risk factors for recurrence and metastasis, 4 cycles of adjuvant chemotherapy are recommended after surgery.
Do I need adjuvant immunotherapy for patients with stage IB lung cancer after surgery?
On March 18, relying on the Impower010 study, atezolizumab was approved by the national NMPA for the treatment of patients with PDL1 expression ≥1%, surgical resection, and platinum-based chemotherapy. – Adjuvant therapy for patients with stage IIIA non-small cell lung cancer (NSCLC). Although stage IB patients were included in the Impower010 study, stratified analysis showed that postoperative adjuvant immunotherapy for stage IB patients did not have a significant statistical advantage. Therefore, currently, the state has not approved the use of postoperative immunotherapy for stage IB patients.