各位好！众所周知多发肺部磨玻璃结节在诊疗决策上具有较多的方式，与患者沟通后的共同决策是重要的干预前手段。今天与大家分享一篇近期发表在JTCVS上的一篇文献，研究对多发肺磨玻璃结节的积极随访研究进行了前瞻性注册数据的展示。多发磨玻璃结节该如何更合理的寻找外科干预指征？值得思考
Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities
James Huang, MD, Kay See Tan, PhD, Nasser Altorki, MD, Mara Antonoff, MD, Shanda Blackmon, MD, Raphael Bueno, MD, Bryan Burt, MD, Todd Demmy, MD, Nathaniel Evans, MD, Laura Donahoe, MD, David Harpole, MD, Doraid Jarrar, MD, Benjamin Kozower, MD, Michael Lanuti, MD, Moishe Liberman, MD, Jules Lin, MD, Douglas Liou, MD, Michael Liptay, MD, James Luketich, MD, Arjun Pennathur, MD, Gerard Petersen, MD, Robert Ripley, MD, Matthew Rochefort, MD, Christopher W. Seder, MD, Joseph Shrager, MD, Stacey Su, MD, Betty Tong, MD, Yaron Shargall, MD, Ara Vaporciyan, MD, Thomas Waddell, MD, Benny Weksler, MD, Dennis Wigle, MD, Sai Yendamuri, MD, David R. Jones, MD
The Journal of Thoracic and Cardiovascular Surgery 19 September 2024
Objective: Presentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs.
目的：多发性毛玻璃影（GGOs）的出现越来越常见，但这些病变的最佳治疗尚不清楚。积极监测已越来越多地被用作其他低级恶性肿瘤的管理策略。我们假设，对于患有多发性肺结节的患者来说，主动监测可能是一种可行且安全的选择。
Methods: Patients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit.
方法：患有≥2个肺结节（毛玻璃为主，实性成分<50%，<3厘米）的患者被纳入多机构登记处，并每6至12个月通过计算机断层扫描进行主动监测进行前瞻性随访。每次随访时，对每个GGO进行单独编目和测量。
Results: Target accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size.
结果：来自23家机构的337名患者纳入了研究。平均年龄为70岁（四分位距，65-77岁），其中74%为女性。大多数人是以前（70%）或现在（9%）吸烟者，平均暴露时间为30包年（四分位间距[IQR]，15-44包年）。一半患者（51%）曾患有肺癌，大多数患者（86%）在进入研究时已经接受监测。每名患者GGOs的中位数为3（IQR，2-5），共有1467个结节接受监测。GGO尺寸中位数为0.9厘米（IQR，0.7-1.3厘米）。大多数GGO的大小为0.5至1厘米。
Conclusions: Active surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.
结论：积极监测而不是立即干预是患者可以接受的选择，并且参加这项登记试验是可行的。将根据方案在计划的5年随访中评估安全性终点和长期结局。
1.首先来看下TSOG的布局，下面的ppt是两年前的情况。
2.上细节：
首先本文是旨在针对2个肺部结节及以上的患者进行的观察性、实效性研究。主要旨在评估low grade恶性肿瘤（附壁型为主、AIS、MIA）观察策略的安全性。其实这个话题并不是什么新鲜话题，单独为入组完成发一篇文章感觉更像是一种TSOG的形象工程。
其次，与该研究设计理念相似的JCOG1906/ECTOP-1021,值得注意的是不同研究的干预指征。对此类低风险肺结节，甲状腺结节中可能的一个思路是射频消融治疗。从甲状腺切除手术直接过渡到观察似乎仍然存在着外科医生的一种倔强，消融不失为治疗选择。但肺癌中的故事呢？
第三，多发肺结节更应关注的是病因角度的理化因素/生物学行为。适应性的随访策略也有助于降低经济学成本。
3. 不同性质的肺结节有不同的观察时间窗，时间窗内的干预/非干预策略可能对肺癌相关死亡并无影响。怎样找到病因学及更加新型有效的治疗方法仍然是研究难点。
目录
1. INTRODUCTION (Figure 1)
2. Material and Methods
2.1 Patient Recruitment and Inclusion and Exclusion Criteria
2.2 Active Surveillance and Guidelines for Intervention
2.3 Assessment Plan
2.4 Primary Outcome and Biostatistics
2.5 Follow-up policy
2.6 Statistical analysis
3. Results (Figure 2)(Table 1)
3.1 Patients
3.2 GGOs (Figure 3)
3.3 Follow-up (Figure 4)
4. Discussion (Figure 5-6)(Table 2)
— 图表汇总—
1. INTRODUCTION
Figure 1. Multiple ground glass opacities (arrows) on representative computed tomography imaging.
3. Results
Figure 2. Thoracic Surgery Oncology Group site activation and patient accrual over time.
Table 1. Participating Thoracic Surgery Oncology Group 102 sites
3.1 Patients
3.2 GGOs
Figure 3. Distribution of the number of ground glass opacities (GGOs) per patient.
3.3 Follow-up
Figure 4. Distribution of individual ground glass opacity size (cm).
4. Discussion
Figure 5. Overview of the study.
Figure 6. Changes in individual ground glass opacity (GGO) size over time in two representative patients.
Table 2. Ongoing prospective trials for active surveillance in patients with ground glass opacities
