Prenzel Klaus L, Mönig Stefan P, Sinning Jan M, Baldus Stefan E, Gutschow Christian A, Grass Guido, Schneider Paul M, Hölscher Arnulf H
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
J Surg Oncol. 2003 Apr;82(4):256-60. doi: 10.1002/jso.10219.
Skip metastasis to mediastinal lymph nodes is a well-known phenomenon in non-small cell lung cancer (NSCLC). Little is reported in the literature about its clinical importance. It is still under discussion whether any prognostic differences exist between resected NSCLC with either skip metastases or continuous mediastinal lymph node metastases (N2).
We analyzed retrospectively the data of 45 patients with a pN2-stage, who underwent resection for NSCLC. Seventeen of these patients (37.8%), showing no metastatic involvement of hilar (N1) lymph nodes, were compared to the remaining 28 patients with infiltration of hilar nodes (N1) as well as N2 nodes.
Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N2 group regarding sex, age, histology, T- or M-status. The frequency of skip metastasis was higher in patients with a primary tumor in the upper lobe (n = 12, 71%) compared to the lower lobe (n = 5, 29%). This difference was not statistically significant. In patients with a non-continuous lymph node spread, 29 out of 119 resected mediastinal lymph nodes were infiltrated (1.7 per patient, range: 1-10). Compared to 83 metastatic involved lymph nodes out of 198 resected mediastinal nodes (three per patient, range: 1-10) in patients with involvement of N1 and N2 nodes (P = 0.034, Mann-Whitney test). The 5-year survival rate of pN2 patients with skip metastasis was 41% compared to 14% in patients with involvement of N1 and N2 nodes (P = 0.019).
pN2 patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN2 patients with continuous infiltration of the regional lymph nodes. Patients with a continuous lymph node involvement show an increased number of infiltrated mediastinal lymph nodes per patient compared to patients with a non-continuous spread. Skip metastasis is an independent prognostic factor of survival. The presence of skip metastasis seems to be a unique subgroup of pN2 disease in NSCLC.
非小细胞肺癌（NSCLC）中跳跃式转移至纵隔淋巴结是一种众所周知的现象。关于其临床重要性，文献报道较少。对于切除的伴有跳跃式转移或连续性纵隔淋巴结转移（N2）的NSCLC患者之间是否存在任何预后差异，仍在讨论中。
我们回顾性分析了45例接受NSCLC切除术的pN2期患者的数据。其中17例患者（37.8%）肺门（N1）淋巴结无转移，将其与其余28例肺门淋巴结（N1）及N2淋巴结均有浸润的患者进行比较。
多因素分析显示，跳跃式转移组与连续性N2组在性别、年龄、组织学、T分期或M分期方面无统计学显著差异。上叶原发性肿瘤患者的跳跃式转移频率（n = 12，71%）高于下叶患者（n = 5，29%）。但这种差异无统计学意义。在淋巴结非连续性转移的患者中，119个切除的纵隔淋巴结中有29个被浸润（每位患者1.7个，范围：1 - 10个）。与N1和N2淋巴结均受累患者的198个切除纵隔淋巴结中的83个转移受累淋巴结（每位患者3个，范围：1 - 10个）相比（曼-惠特尼检验，P = 0.034）。pN2期伴有跳跃式转移患者的5年生存率为41%，而N1和N2淋巴结均受累患者为14%（P = 0.019）。
与区域淋巴结连续性浸润的pN2患者相比，纵隔淋巴结跳跃式转移的pN2患者预后更有利。与非连续性转移的患者相比，淋巴结连续性受累的患者每位患者浸润的纵隔淋巴结数量增加。跳跃式转移是生存的独立预后因素。跳跃式转移的存在似乎是NSCLC中pN2疾病的一个独特亚组。
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