外科手术在Ⅲ期-NSCLC-多学科治疗中占重要地位

如此情况下，我们该如何当老师呢？梁教授通过分享自己在实际中如何去安排复杂多样的工作任务、生活的琐事therealimplementationofthequasi,ruthless.Tough,requirement,carryforwardthespiritofanail,andthecorrectivemeasuresTheimplementationofthenerveendings,donotlettherectificationisnotinplace,nottoretreat,thepeoplearenotsatisfied.Pinfouristoadheretothereformandinnovation.Toreformthewayofthinkingandinnovativecouragetoturnstyle,againstfourwinds,thecouragetofacethecontradictions,goodatsolvingthechronicills,daretobreaktheoutdatedcustomsandbadhabitsHenshaunhealthytendencies,trees,freshhealthy.Thefiveistoadheretotacklingtheproblem.ThatisthewindSuJiandtheeducationsupervisioncombined,inordertoestablishanewsystemtopromotethenormalizationofstylebuilding,long-term,toenhancethepartyspiritofhonestandpragmaticpeoplethoughtconsciousaction.Thesixistoinsistonthecompletionofthethirdgrasptheoverallsituation.ActivityandendThisyearthegoalofsafetyproductionworkplanfornextyear,worktogether,topromotetheactivitiesandtheworkofproductionsafetywithbothhands,twopromotion,twonotmistake.Two,rectificationoftheoverallobjectivesandspecificobjectives:(a)theoverallpatharoundthefourfocus,carriedouttheoutstandingproblemsofthespecialrectification,thefullimplementationofthecentralandprovincialPartycommitteecleartherectificationtask,effectivelycurbthefourwinds,realizetheoverallimprovementofPartyandgovernment.Thepointis:focusonthepeople,thepeople,convenience,andresolutelycurbthebureaucraticstyleofwork;lookingtostimulategrassrootsvitality,resolutelycurbtheWenshansea;focusonthecadreshonest,cleangovernment,politics,andresolutelycurbexceedthestandardQuasioccupiedofficespace,Gongjusiyong,publicfunds,extravaganceofthewind;focusonestablishacorrectviewofachievements,theconceptofpower,andresolutelycurbactsagainsttheinterestsofthemasses.Acceleratethesystemreformandconstruction,improvethepeoplehonestandpragmaticnormalizationsystem,constantlyconsolidateandexpandeducationalpracticeachievements,makepeoplesatisfied.Therecentreformgoal:PoliticalQualityBureauandallPartymembersandcadres,furtherimprovethequalityofthebusiness;thefourwinds,twoproblemhasbeeneffectivelysolved.Themiddlegoalofthereform:oppositionpartyandgovernmentausteritywaste外科手术在Ⅲ期NSCLC多学科治疗中占重要地位Ⅲ期NSCLC由多种不同分期(如T4N0-3,T3N1-3和T1a-2aN2-3)组成，因而很难确定一个统一的治疗方案。该文总结了回顾性和前瞻性研究结果表明虽然外科手术在Ⅲ期NSCLC患者的多学科治疗中占重要地位，然而对那些纵隔淋巴结转移的患者而言，手术治疗仍然具有争议。一、背景癌症相关死亡人数不断增加，在许多发达国家包括日本肺癌是最主要的死亡原因。NSCLC中大部分为腺癌和鳞癌(分别为肺癌的60%和25%)，新的诊断和治疗方法层出不穷，但是疗效欠佳。治疗肺癌患者时必须确定患者的年龄、性别、体力状态、病理亚型和肿瘤的分子背景等。Ⅰ期和Ⅱ期NSCLC通过完整切除病灶所在的肺叶或更多的肺组织可以获得满意疗效，这些患者可从辅助化疗中获益，化疗方案包括以铂类或尿嘧啶和喃氟啶为基础的化疗。Ⅳ期NSCLC患者以化疗为主。现有的基础和临床研究发现，治疗这类患者时，需检测基因表达（如EGFR，ALK等)，因为具有致癌基因突变的患者，特异性激酶抑制剂可使其获益。局部晚期(如Ⅲ期)NSCLC患者，单用外科治疗不能控制局部复发和远处转移。巴塞罗那研究小组和M.D.安德森研究小组的回顾性研究证实诱导化疗后予以外科治疗较单纯手术治疗的效果好。然而，关于诱导治疗后进行手术治疗的Ⅲ期NSCLC患者，4项随机对照试验未能证实化疗和放疗诱导治疗后外科治疗的方案更优。根据这些研究，目前就Ⅲ期NSCLC的治疗还未达成一致共识。一些回顾性和前瞻性研究已经证实同期放化疗后手术治疗安全和有效，但美国胸外科医师协会(ACCP)指南表明局部晚期NSCLC患者的治疗仍然具有争议。鉴于此，日本九州国家癌症中心的GoujiToyokawa教授等总结了回顾性和前瞻性研究结果，这些研究分析联合手术的多学科治疗对Ⅲ期NSCLC患者的重要性，特别是存在纵隔淋巴结转移的患者。文章发表在2014年7月的clincallungcancer杂志上。二、N2阳性的Ⅲ期肺癌的外科治疗指征具有N2阳性的NSCLC，特别是多个N2阳性的患者，已证实外科切除预后差，这类患者最佳的治疗方案还未确定。根据ACCP临床实践指南，治疗策略取决于淋巴结状态，分为“侵袭型”或“孤立型”。侵袭型指广泛纵隔淋巴结转移的患者，肿瘤侵袭到纵隔组织，包绕主要的结构如大血管和气管。推荐铂类为基础的化疗和放疗(60-66Gy)联合治疗侵袭型肺癌，而不推荐新辅助或放化疗后联合手术治疗。相反，孤立型指那些能够彼此区分开的单发纵隔淋巴结转移患者。指南推荐这类患者可以在末次化疗结束后或诱导治疗结束后进行外科手术，而不是单独的外科治疗或放疗。当考如此情况下，我们该如何当老师呢？梁教授通过分享自己在实际中如何去安排复杂多样的工作任务、生活的琐事therealimplementationofthequasi,ruthless.Tough,requirement,carryforwardthespiritofanail,andthecorrectivemeasuresTheimplementationofthenerveendings,donotlettherectificationisnotinplace,nottoretreat,thepeoplearenotsatisfied.Pinfouristoadheretothereformandinnovation.Toreformthewayofthinkingandinnovativecouragetoturnstyle,againstfourwinds,thecouragetofacethecontradictions,goodatsolvingthechronicills,daretobreaktheoutdatedcustomsandbadhabitsHenshaunhealthytendencies,trees,freshhealthy.Thefiveistoadheretotacklingtheproblem.ThatisthewindSuJiandtheeducationsupervisioncombined,inordertoestablishanewsystemtopromotethenormalizationofstylebuilding,long-term,toenhancethepartyspiritofhonestandpragmaticpeoplethoughtconsciousaction.Thesixistoinsistonthecompletionofthethirdgrasptheoverallsituation.ActivityandendThisyearthegoalofsafetyproductionworkplanfornextyear,worktogether,topromotetheactivitiesandtheworkofproductionsafetywithbothhands,twopromotion,twonotmistake.Two,rectificationoftheoverallobjectivesandspecificobjectives:(a)theoverallpatharoundthefourfocus,carriedouttheoutstandingproblemsofthespecialrectification,thefullimplementationofthecentralandprovincialPartycommitteecleartherectificationtask,effectivelycurbthefourwinds,realizetheoverallimprovementofPartyandgovernment.Thepointis:focusonthepeople,thepeople,convenience,andresolutelycurbthebureaucraticstyleofwork;lookingtostimulategrassrootsvitality,resolutelycurbtheWenshansea;focusonthecadreshonest,cleangovernment,politics,andresolutelycurbexceedthestandardQuasioccupiedofficespace,Gongjusiyong,publicfunds,extravaganceofthewind;focusonestablishacorrectviewofachievements,theconceptofpower,andresolutelycurbactsagainstthei