In the exploration of the medical field, we have stepped into the deep exploration of the problem of early lung cancer, and found that this field is not as simple as we imagined. Not just an early class, but an institution full of trials and challenges, and every student has an unknown story to tell.
First, let's understand that early lung cancer is like a student's class. Stage I is the initial period and is also the time when the treatment is most effective. However, in this seemingly shining Phase I class, we found that the students with the highest scores, who are the "top students" with solid nodules, a high proportion of high-grade subtypes, high-risk factors, and driver gene mutations, are gradually becoming the focus of medical research.
This particular group of students is actually a vector of the risks and challenges faced by early-stage lung cancer. Just like the top students, their existence makes the overall average score line passively raised, covering up the existence of some "poor students". So, who are these "bad students"?
Through the sharing of cases, we have a deeper understanding of this problem. A 49-year-old woman, a former Phase I student, underwent surgery and lymph node dissection, and everything seemed to be going well. However, she refused postoperative adjuvant targeted therapy for personal reasons after surgery. Time flies, and at the beginning of 2024, she appeared in front of the doctor again, seemingly recovering well, but showed obvious swelling of lymph nodes on CT, and the marker detection was also abnormal. She originally thought that she had obtained a "graduation certificate" for early-stage lung cancer, but in this short period of time, she ushered in the test of recurrence.
This is not an isolated case. More cases tell us that stage I lung cancer does not mean safe. Some patients ushered in the haze of recurrence half a year after surgery, as if the whole treatment process was just a passing scene. One of the patients, despite the ADAURA regimen of oral osimertinib, relapsed within half a year, becoming a difficult puzzle to solve.
All of this has forced us to re-examine early-stage lung cancer and focus on high-risk students who are hiding in the Phase I class. From the perspectives of imaging, pathology, high-risk factors, and driver genes, solid nodules, high-grade subtypes have a high proportion, high-risk factors, the presence of driver gene mutations, incomplete surgery, and inadequate postoperative adjuvant treatment, which together constitute the most at-risk student group.
Looking back at the case, a female patient had solid nodules, with 80% of high-grade subtypes, combined with airspace dissemination, and even though the operation was completed thoroughly and perfectly, lymph node recurrence still appeared six months after surgery. Another patient, despite receiving the ADAURA regimen, also showed signs of relapse within six months. All of this makes us have to realize that even in the class of Phase I, there are poor students, and there are also students who may not be selected.
In this lung cancer classroom, we need to be sensitive to these high-risk students. The higher the solid component, the greater the risk, the more invasive component, the greater the risk, the higher the risk with the higher the risk factor, the higher the risk due to the presence of driver mutations, and the higher the risk due to incomplete surgery. These high-risk students may be the real challenge to the prognosis of early-stage lung cancer.
How to deal with these high-risk students? Surgery, targeting, MRD (Minimal Residual Disease) are all life-saving tools. However, as in the Mariana Trench, which is the deepest part of the Pacific Ocean, we must be more cautious, because dangerous moments can emerge inadvertently.
Early stage lung cancer is a life-saving test. In this examination room, every student should pay enough attention. We need to abandon the over-optimism of the past about stage I lung cancer, and be more cautious about those students who may not be selected, because it is these students who give us a deeper understanding of the complexity of early-stage lung cancer and awaken our appreciation for life and awe for the unknown.