Misthos P, Sepsas E, Athanassiadi K, Kakaris S, Skottis I
1st Thoracic Surgical Department, General Hospital for Chest Diseases SOTIRIA, 7 P. Dimitrakopoulou Street, 11141 Athens, Greece.
Eur J Cardiothorac Surg. 2004 Apr;25(4):502-8. doi: 10.1016/j.ejcts.2004.01.025.
To determine the clinical significance of skip metastases (pN2/S) in patients with resected pIIIA/N2 NSCLC. The incidence of pN2/S after mediastinal lymph node dissection (MLD) and sampling (MLS) were compared.
From 1997 to 2000, 580 lung resections for NSCLC performed at our department. The 151 patients (26.5%) at stage IIIA/N2 (pN2+) were grouped according to their skip metastases status. Group A included the ordinary pN2 (pN2/O) cases (71%) and group B the pN2/S (29%). Age, gender, type of resection, right or left lesion, histology, tumor lobe predilection, MLD or MLS pathologic results, the level and the number of node stations involved and survival were analyzed.
In 44 patients (29%) pN2/S disease was present. Statistical analysis revealed significant difference between pN2/O and pN2/S for the following: (1) pN2/S was more common for right-sided lesions (P=0.007); (2) Squamous carcinoma was the main type of pN2/S (P=0.007) and (3) pN2/S was more frequently detected after MLD than after MLS (P=0.001). Although pN2/S involved more often upper mediastinal lymph nodes (Nos. 2, 3) and one station level (pN2/S: 41 vs. pN2/O: 19.6%, P=0.228) was not found statistically significant. pN2/O was more common after right upper lobectomy and pN2/S after right lower lobectomy. The 3-year survival was more favorable for the pN2/S group (A: 24 vs. B: 36%, P=0.07).
(1) MLD was found to be more reliable for pN2/S detection than MLS. (2) The presence of pN2/S proved to be a less aggressive form of lymphatic spread that should be taken into account in the future. (3) Strong correlation between right lower lobe tumors and pN2/S was demonstrated. (4) Different routes of cancer lymphatic spread between pN2/S and pN2/O are suggested.
确定在接受手术切除的IIIA期/N2期非小细胞肺癌（NSCLC）患者中跳跃转移（pN2/S）的临床意义。比较纵隔淋巴结清扫术（MLD）和纵隔淋巴结采样术（MLS）后pN2/S的发生率。
1997年至2000年，我科对580例NSCLC患者实施了肺切除术。将151例IIIA期/N2期（pN2+）患者根据其跳跃转移状态进行分组。A组包括普通pN2（pN2/O）病例（71%），B组为pN2/S病例（29%）。分析了年龄、性别、切除类型、病变位于右侧还是左侧、组织学类型、肿瘤好发肺叶、MLD或MLS的病理结果、受累淋巴结站的水平和数量以及生存率。
44例（29%）患者存在pN2/S病变。统计分析显示pN2/O和pN2/S在以下方面存在显著差异：（1）pN2/S在右侧病变中更常见（P=0.007）；（2）鳞状细胞癌是pN2/S的主要类型（P=0.007）；（3）MLD后比MLS后更频繁检测到pN2/S（P=0.001）。虽然pN2/S更常累及上纵隔淋巴结（第2、3组），且一个淋巴结站水平（pN2/S：41%对pN2/O：19.6%，P=0.228）未发现有统计学意义。右上叶切除术后pN2/O更常见，右下叶切除术后pN2/S更常见。pN2/S组的3年生存率更有利（A组：24%对B组：36%），P=0.07）。
（1）发现MLD在检测pN2/S方面比MLS更可靠。（2）pN2/S的存在被证明是一种侵袭性较小的淋巴转移形式，未来应予以考虑。（表明右下叶肿瘤与pN2/S之间存在强相关性。（4）提示pN2/S和pN2/O之间存在不同的癌性淋巴转移途径。
