智提琳,祁艳娟

肺癌作为一种影响人体健康的严重疾病，在世界各地都呈现出了日益增长的趋势。根据相关数据显示，肺癌的发病率正以惊人的速度攀升，而死亡率更是居高不下。寡转移性肺癌，这个在肺癌群体中颇具特点的疾病，正以其独特的临床表现和复杂的治疗挑战而引起医学界的广泛关注。因此，对寡转移性肺癌的研究，已成为医学领域中一个活跃且充满活力的分支。寡转移性肺癌是介于局限性和多发转移之间的一种特殊生物学状态，具有温和侵袭性，转移瘤数目有限并且转移器官具有特异性。本文综述了寡转移性肺癌的定义、诊断标准及在现代医疗领域中治疗进展，这些显著的进展涵盖了多种局部治疗手段，包括精准的手术切除、局部治疗、化疗。通过这些综合治疗策略，不仅可以为肿瘤提供有效的控制，而且有助于延缓肿瘤的生长和扩散速度，从而改善患者的预后。

肺癌；寡转移；诊断；治疗进展

[1] Xhaferllari I,El-Sherif O,Gaede S,et al.Comprehensive dosimetric planning comparison for early-stage,non-small cell lung cancer with SABR:fixed-beam IMRT versus VMAT versusTomoTherapy[J].J Appl Clin Med Phys.2016Sep;17(5):1-12. [2] KATARIAN,NAGAP,BANERJEES,et al.CyberKnife stereotac-tic ablative radiontherapy for recurrent or oligometastatic gynecologi-cal cancers[J].South AsianJ Cancer,2021,10(2):107-111. [3] WANG XS,BAI YF,VERMA V,et al.Randomized trial of first-line tyrosine kinase inhibitor with or without radiontherapy for syn- chonous oligometastatic EGFR-mutated non-small cell lung cancer[J].J Natl Cancer Inst,2023,115(6):742-748. [4] UPPAL ABHINEET,FERGUSON MARK K,POSNER MITCH-ELLC,et al.Towards a moiecular basis of oligometastatic dis-ease: potential role of miro-RNAs[J].Clin Exp Metastasis,2014,31(6):735-758. [5] DEEK MP,VAN DER EECKEN K,PHILLIPS R,et al.The muta-tional landscope of metsatatic castration-sensitive prostate cancer:The spectrum theory revisited[J].Eur Urol,2021,80(5):632-640. [6] OKA R,UTSMI T,NORO T,et al.Progress in oligometastatic prostate cancer:Emerging imaging innovations and therapeutic ap⁃proaches[J].Cancers(Basel),2024,16(3):507. [7] MESKO SHANE,SANDLERKIRI,COHEN JOSHUA,et al.Clinical outcomes for stereotactic ablative radiotherapy in oligometastatic and oligoprogressive gynecological malignancies[J].Int J Gynecol cancer,2017,(2):403-408. [8] MAHJOUB S,HEIDENREICH A.Oligometastatic prostate cancer:definition and the role of local and systemic therapy:a narrative review[J].Transl Androl Urol,2021,10(7):3161-3175. [9] Crui ckshank A,Stieler G,Ame er F.Evaluation of the solitary pulmonary nodui e[J].Internal Medicine Journal,2019,49(2):306-315. [10] WEIR-MCCALL J R,HARRIS S,MILES K A,et al.Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT:the SPUTNIK trial[J].European Journal of Nuclear Medicine and Molecular Imaging, 2021,48(5):1560-9. [11] ERDOĞAN M,EVRIMLERŞ,AYDıN H,et al.Solitary Pulmonary Nodule:Morphological Effects on Metabolic Activity Assessment[J]. Molecular Imaging and Radionuclide Therapy,2019,28(3):112-9. [12] 郭成伟,陈为军,梁文.18F标记脱氧葡萄糖PET-CT结合320排CT双入口灌注成像在孤立性肺结节中的诊断价值[J].临床误诊误治,2019,32:71-6. [13] 王国鑫,陆锡波.恶性肿瘤患者伴发或新发孤立性肺结节的CT表现及诊断价值分析[J].中国基层医药,2021,28:1560-3. [14] DIGUMARTHY S R,PADOLE A M,LO GULLO R,et al.CT texture analysis of histologically proven benign and malignant lung lesions[J].Medicine,2018,97(26):e11172.[14]代王朔,郝月琴,常金,等.基于结节最大径建立的孤立性肺结节良恶性预测模型[J].中国临床医生杂志,2022,50:150-5. [15] 张春.孤立性肺部分实性结节CT影像表现与肺腺癌病理亚型对照分析[J].影像研究与医学应用,2022,6:17-9. [16] 张春.孤立性肺部分实性结节CT影像表现与肺腺癌病理亚型对照分析[J].影像研究与医学应用,2022,6:17-9. [17] KIM T J,KIM C H,LEE H Y,et al.Management of incidental pulmonary nodules:current strategies and future perspectives[J].Expert Review of Respiratory Medicine,2020,14(2):173-94. [18] Corona-Cruz JF,Domínguez-Parra LM,Saavedra-Pérez D,et al.Lung metastasectomy:Long-term outcomes in an 18-year cohort from a single center.Surg Oncol,2012,21(3):237-244. [19] McCormack PM,Martini N.The changing role of surgery for pulmonary metastases.Ann Thorac Surg,1979,28:139. [20] Joosten J,Bertholet J,Keemers-Gels M,et al.Pulmonary resection of colorectal metastases in patients with or without a history of hepatic metastases.J Cancer Surg,2008,34(8):895-899. [21] Macherey S,Doerr F,Heldwein M,et al.Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy? Interact Cardiovasc Thorac Surg,2016,22(3):351-359. [22] Gonzalez M,Brunelli A,Szanto Z,et al.Report from the European Society of Thoracic Surgeons database 2019:Current surgical practice and perioperative outcomes of pulmonary metastasectomy.Eur J Cardiothorac Surg,2021,59(5):996-1003. [23] Cheung F,Alam N,Wright G.Pulmonary metastasectomy:Analysis of survival and prognostic factors in 243 patients.ANZ J Surg, 2018,88(12):1316-1321. [24] 高树庚,邱斌,郭晓彤,等.胸腔镜解剖性部分肺叶切除手术技巧.中华胸部外科电子杂志,2016,3(2):122-124. [25] Shiono S,Okumura T,Boku N,et al.Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg,2017,51(3):504-510. [26] Gomez DR,Blumenschein GRJ,Lee JJ,et al.Local consoli⁃dative therapy versus maintenance therapy or observation for pa⁃tients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy:a multicentre,ran-domised,controlled, phase 2 study[J].Lancet Oncol,2016,17(12):1672-1682. [27] Gomez DR,Tang C,Zhang JJ,et al.Local consolidative ther-apy Vs.maintenance therapy or observation for patients witholigometastatic Non-Small-Cell lung cancer:Long-Term results of a Multi-Institutional,phase II,randomized study[J].J Clin Oncol,2019, 37(18):1558-1565. [28] Wang XS,Bai YF,Verma V,et al.Randomized trial of First-Line tyrosine kinase inhibitor with or without radiotherapy for synchronous oligometastatic EGFR⁃Mutated Non⁃Small cell lung cancer[J].J Natl Cancer Inst,2023,115(6):742-748. [29] Katz LM,Ng V,Wu SP,et al.Stereotactic body radiation therapy for the treatment of locally recurrent and oligoprogres-sive Non-Small cell lung cancer:a single institution experience[J].Front Oncol,2022,12:870143. [30] Meng CL,Wang F,Tian J,et al.Risk prediction model for synchronous oligometastatic Non-Small cell lung cancer:tho-racic radiotherapy May not prolong survival in High-Risk pa-tients[J].Front Oncol,2022,12:897329. [31] de Baère T,Aupérin A,Deschamps F,et al.Radiofrequency ablation is a valid treatment option for lung metastases:experi-ence in 566 patients with 1037 metastases[J].Ann Oncol,2015,26(5):987-991. [32] Wei ZG,Yang X,Ye X,et al.Microwave ablation plus chemotherapy versus chemotherapy in advanced non⁃small cell lung cancer:a multicenter,randomized,controlled,phase III clinical trial[J].Eur Radiol,2020,30(5):2692⁃2702. [33] Feng K,Lu Y.Clinical analysis of systemic chemotherapy combined with microwave ablation in the treatment of lung cancer[J].Asian J Surg,2022,45(5):1107-1112. [34] Ni Y,Ye X,Yang X,et al.Microwave ablation as local con-solidative therapy for patients with extracranial oligometastatic EGFR- mutant non-small cell lung cancer without progression after first-line EGFR-TKIs treatment[J].J Cancer Res Clin Oncol, 2020, 146(1):197-203. [35] Picchi SG,Lassandro G,Bianco A,et al.RFA of primary and metastatic lung tumors:long⁃term results[J].Med Oncol,2020,37(5):35. [36] Callstrom MR,Woodrum DA,Nichols FC,et al.Multicenter study of metastatic lung tumors targeted by interventional cryoa⁃blation evaluation(SOLSTICE)[J].J Thorac Oncol,2020,15(7):1200-1209. [37] 蔡明辉,申屠阳,肺部转移性肿瘤的临床诊治策略[J]中国肺癌杂志2014年3月第17卷第3期｡ [38] Verma S,Clemons M.First-line treatment options for patients with HER2 negative metastatic breast cancer.the inpact of modem adjuvant chemotherapy.Oncologist,2007,12:785-797. [39] Barth A,Wanck LA,Morton D.Prognostic factors in 1521 melanoma patients with distant metastases.J Am Coll Surg,1995,181(2):193-201.

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