Schirren J, Bergmann T, Beqiri S, Bölükbas S, Fisseler-Eckhoff A, Vogt-Moykopf I
Thorac Cardiovasc Surg. 2006 Sep;54(6):373-80. doi: 10.1055/s-2006-924194.
The aim of this study was to describe lymphatic spread in resected lung cancer patients and evaluate for the presence for a reliable sentinel lymph node. Onethousand and eighty-eight patients with NSCLC underwent resection. Twelve to sixteen percent of the patients with primaries in the upper lobes had an involvement in the upper mediastinum; in 12 %, it was subcarinal, in 6 % and 3 %, in the lower mediastinum at paraoesophageal and ligamentum pulmonale sites, respectively. The rate of "lymph node skipping" is between 31 and 74 %. An isolated involvement of mediastinal nodes is possible without involvement of the N-1 position. Irrespective of the location of the primary tumour, there is a high incidence of "lymph node skipping" because of the specific architecture of the pulmonary, hilar and medistinal lymph nodes. Therefore, a reliable sentinel lymph node in lung cancer cannot be defined. In conclusion, systematic lymph node dissection in anatomical compartments is the gold standard for evaluation of the exact pN stage. Furthermore, a complete R/O-resection is a prognostically relevant factor in the surgery of NSCLC.
本研究的目的是描述接受手术切除的肺癌患者的淋巴扩散情况，并评估是否存在可靠的前哨淋巴结。1088例非小细胞肺癌患者接受了手术切除。上叶原发性肿瘤患者中有12%至16%的患者上纵隔受累；12%为隆突下受累，6%和3%分别为食管旁和肺韧带部位的下纵隔受累。“淋巴结跳跃”率在31%至74%之间。纵隔淋巴结可单独受累而N-1部位不受累。无论原发性肿瘤的位置如何，由于肺、肺门和纵隔淋巴结的特殊结构，“淋巴结跳跃”的发生率都很高。因此，无法定义肺癌中可靠的前哨淋巴结。总之，在解剖区域进行系统性淋巴结清扫是评估准确pN分期的金标准。此外，完全R/O切除是NSCLC手术中一个与预后相关的因素。
