2024-02-10 03:50:22
Precisely position one-stop surgical treatment for early-stage lung cancer. Pay attention to immune checkpoints after surgery to prevent the risk of recurrence.
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For early-stage lung cancer that can be operated on, surgery and postoperative adjuvant treatment are the key to influencing the prognosis. This care online specially invited Dr. Huang Caiwang from the Thoracic Surgery Department of the Tri-Service General Hospital to publicly analyze the key points of surgery, team care, and new breakthroughs in postoperative auxiliary treatment.
In recent years, the National Health Administration has included low-dose computed tomography LDCT for lung cancer as the fifth cancer screening test in my country, with the goal of early detection of lung cancer through low-dose computed tomography LDCT to improve the overall prognosis. Dr. Huang Caiwang from the Thoracic Surgery Department of the Tri-Service General Hospital pointed out that in recent years, low-dose computed tomography has been effective in detecting many early-stage lung cancers, and the number of patients who can undergo surgery has also increased. At the same time, surgery and postoperative treatment for early-stage lung cancer have also continued to develop. The prognosis of lung cancer has been greatly improved.
Accurately locate and remove minor signs of disease, one-stop surgery shortens operation time and effectively reduces complications
First of all, lung tumors detected through low-dose computed tomography are generally small and ground-glass-shaped. It is difficult to find the lesions during endoscopic surgery. The exact location of the tumor needs to be stereoscopically localized before surgery for accurate resection. Dr. Huang Caiwang explained that in the past, patients usually had to go to the examination room for positioning before entering the operating room for surgery. This approach was time-consuming and would increase the risk of pneumothorax and hemoptysis during transportation and waiting.
In order to optimize the process, the Tri-Service General Hospital began to perform one-stop stereotaxic surgery for lung tumors in 2018. As the name suggests, patients can complete stereotaxic surgery and surgical resection in the same operating room. Dr. Huang Caiwang said that one-stop lung tumor stereotaxic surgery can effectively reduce the transportation and waiting time, and reduce the patient’s time between stereotaxy and surgery. The anxiety and discomfort also greatly reduce the chance of related complications (such as pneumothorax, hemothorax).
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At present, the Thoracic Surgery Department of the Tri-Service General Hospital has accumulated a lot of experience. It can complete stereotaxic and sequential resection surgeries in about 10 minutes, and the success rate of localized resection surgeries is greater than 90%.
The green channel takes into account the needs of patients in an all-round and fast manner, and the cross-disciplinary team makes treatment more efficient.
Lung cancer patients have diverse needs for testing, treatment, and daily care, and often require the participation of multiple departments. The Tri-Service General Hospital has also set up a multi-specialty lung cancer team for this purpose.
Dr. Huang Caiwang said that the members of the lung cancer multi-specialty team include thoracic surgery, pathology, diagnostic radiology, radiation oncology, rehabilitation, psychologists, case managers, etc., and the unique Chinese medicine team of the three major associations has also joined. Respective medical professions help patients.
Team members from each department will hold regular meetings to brainstorm and formulate appropriate personalized treatment plans for lung cancer patients. Green channels are also set up to provide integrated outpatient clinics, which help reduce the time spent traveling between departments and waiting for examinations, greatly improving the convenience of medical treatment.
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Early lung cancer reduces the risk of recurrence, and immune checkpoints should not be forgotten in postoperative adjuvant treatment
In order to cure early-stage lung cancer after surgery, the most important thing to know is postoperative adjuvant treatment. Dr. Huang Caiwang explained that after surgical treatment, the five-year survival rate of stage 1A lung cancer patients can reach more than 90%, and the five-year survival rate of stage 1B lung cancer patients is about 85%. In stage 2, the five-year survival rate drops to about 60%, and in stage 3, it will drop to about 60%. to less than 50%, it can be seen that the risk of recurrence is still serious.
Therefore, doctors usually arrange postoperative adjuvant treatment for patients with stage 2 or above, and if stage 1B has a higher risk of recurrence, postoperative adjuvant treatment will also be recommended. Dr. Huang Caiwang said that traditional postoperative adjuvant treatment is mainly chemotherapy, and the effect is not satisfactory. In recent years, EGFR targeted therapy and immunotherapy have also been used in postoperative adjuvant treatment, which has greatly improved the efficacy.
Dr. Huang Caiwang further explained that if EGFR gene mutation is found in genetic testing, the corresponding targeted drug can be used; if there is no EGFR mutation, then the tumor can be observed to see whether it has immune checkpoint PD-L1 performance, and if so, PD-L1 can be considered Immunotherapy with inhibitors.
The so-called PD-L1 inhibitor is a type of immunotherapy that inhibits cancer cells from using the immune checkpoint mechanism to evade T cell attack.
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Dr. Huang Caiwang explained that when T cells in the immune system have the ability to recognize and kill cancer cells, the cancer cells may produce PD-L1 on the cell surface in order to protect themselves. When PD-L1 binds to PD-1 on the T cells, When, T cell attack will be inhibited. At this time, PD-L1 inhibitors can be used to prevent PD-L1 from binding to PD-1, allowing T cells to attack and kill cancer cells.
PD-L1 inhibitors “remove makeup” from cancer cells. Discuss PD-L1 performance testing with your doctor before surgery.
“Cancer cells with PD-L1 are like having the ability to camouflage and can escape the attack of T cells.” Dr. Huang Caiwang described, “PD-L1 inhibitors can disable the camouflage, causing the cancer cells to show their original shape, and T cells can attack Cancer cells are on a killing spree.” The results of clinical trials show that postoperative adjuvant treatment using chemotherapy followed by PD-L1 inhibitors can reduce the risk of recurrence by about 30 to 55%, depending on the patient’s own PD-L1 expression.
Dr. Huang Caiwang further explained that for patients with higher PD-L1 expression, PD-L1 inhibitors can usually be expected to have better therapeutic effects, so it is recommended that patients undergo PD-L1 testing before planned treatment. Since the detection of PD-L1 expression requires the use of tumor biopsy specimens, in order to make the detection process smoother and treatment more efficient, it is recommended that patients discuss PD-L1 detection with their doctors “before surgery” to avoid the possibility of insufficient specimens in the future. doubt.
Dr. Huang Caiwang also emphasized that the existing health insurance resources are limited. Considering the urgency of treatment, although there are currently more resources for late-stage patients, they have gradually moved towards early stages. As a doctor, for the benefit of the patient, regardless of whether there is health insurance payment or not, We will try our best to let patients know all possible treatment information, fully communicate between doctors and patients, and fully protect the rights of patients.
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