摘要
目的探究pT1期非小细胞肺癌N2淋巴结转移特点及其影响因素,为术中更加准确地行系统的淋巴结清扫以及术后准确的病理分期提供依据。方法回顾性分析2013年5月到2018年12月在华中科技大学同济医学院附属同济医院胸外科行肺癌根治术的48例患者的临床资料,其中男性32例,女性16例,年龄38~70(57.8±7.2)岁。依据术后病理结果,将N2淋巴结转移的患者分为跳跃转移组和非跳跃转移组,其中跳跃转移组15例,非跳跃转移组33例,分析N2淋巴结转移特点和跳跃转移特点及其影响因素。结果 pT1期N2淋巴结转移以腺癌(87.5%)、外周型病灶(70.8%)及pT1c(64.6%)期多见,主要手术方式为肺叶切除,所有患者N2淋巴结转移率为16.3%,N1淋巴结转移率为11.7%,N2淋巴结转移更多发生在隆突下(27.8%)及上纵隔淋巴结(47.5%),发生下纵隔淋巴结转移概率极低(1.6%);上叶肺癌以上纵隔及隆突下淋巴结转移为主,下叶肺癌以隆突下淋巴结转移为主;右肺癌主要是2/3/4/7组淋巴结转移,左肺癌主要是6/7组淋巴结转移;对比两组临床资料,在术后病理分化程度上有显著性差异(P<0.01),然而在年龄、性别、吸烟史、家族史、肿瘤大小、肿瘤位置、术前癌胚抗原(CEA)水平及肿瘤病理类型上均无差异性。结论 pT1期肺腺癌及外周型病灶较容易发生N2淋巴结转移,在行肺癌根治术时,应重点清扫隆突下及上纵隔淋巴结;对于pT1期非小细胞肺癌,肿瘤直径越大,越容易发生N2淋巴结转移;年龄、性别、吸烟史、家族史、肿瘤大小、肿瘤位置、术前CEA水平及肿瘤病理类型与早期非小细胞肺癌是否发生N2淋巴结跳跃转移无明显的相关性,肿瘤分化程度的高低可能是早期非小细胞肺癌发生N2淋巴结跳跃转移的影响因素。
Objective To investigate the characteristics and influencing factors of lymph node metastases(N2)in pT1 stage non-small cell lung cancer,and to provide the basis for more accurate dissection of systemic lymph node and pathological staging.Methods Clinical data of 48 patients undergoing radical surgery in Tongji Hospital from May 2013 to December 2018 were retrospectively analyzed,including 32 males and 16 females,aged 38-70(57.8±7.2)years.According to postoperative pathological results,patients with N2 lymph node metastasis were divided into skip metastasis group and non-skip metastasis group,including 15 cases in skip group and 33 cases in non-skip group.The characteristics and influencing factors of N2 metastasis were analyzed.Results N2 metastasis in pT1 stage NSCLC was more common in adenocarcinoma(87.5%),peripheral type(70.8%)and pT1 c(64.6%).The main surgical procedure was lobectomy.The positive rate of N2 lymph node metastasis was 16.3% in all the patients.The positive rate of N1 lymph node metastasis was 11.7%,N2 metastasis occurred more in subcarinal lymph nodes(27.8%)and upper mediastinal lymph(47.5%),the probability of lower mediastinal lymph node metastasis was very low(1.6%);upper mediastinum and subcarinal lymph nodes metastasis were the main metastasis in the upper lung cancer,the lower lung cancer was mainly accompanied with the subcarinal lymph node metastasis;the right lung cancer was mainly accompanied with 2 nd/3 rd/4 th/7 th group lymph node metastasis,the left lung cancer was mainly accompanied with the 6 th/7 th group lymph node metastasis.There was a significant difference in the degree of pathological differentiation between the two groups(P<0.01).However,there were no differences in age,gender,smoking history,family history,tumor size,tumor location,preoperative CEA level and tumor pathological type.Conclusion pT1 stage lung adenocarcinoma and peripheral lesions are more prone to N2 lymph node metastasis.In the radical resection of lung cancer,the subcarinal and superior mediastinal lymph nodes should be cleaned.For pT1 NSCLC,the larger the tumor diameter,the more prone to N2 lymph node metastasis;age,gender,smoking history,family history,tumor size,tumor location,preoperative CEA level and tumor pathological type have no significant correlation with N2 lymph node metastasis,the degree of tumor differentiation may be the influencing factor of N2 skip metastasis in early non-small cell lung cancer.
作者
屈日荣
别磊
平伟
付向宁
Qu Rirong;Bie Lei;Ping Wei(Department of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2020年第1期58-61,共4页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词
pT1期肿瘤
非小细胞肺癌
淋巴结转移
手术治疗
tumor in pT1 stage
non-small cell lung cancer
lymph node metastasis
surgical treatment
