基于非小细胞肺癌患者转移淋巴结的微观包膜外扩展来确定最佳临床靶区边界。

Determining optimal clinical target volume margins on the basis of microscopic extracapsular extension of metastatic nodes in patients with non-small-cell lung cancer.

作者信息

Yuan Shuanghu, Meng Xue, Yu Jinming, Mu Dianbin, Chao K S Clifford, Zhang Jiandong, Zhong Weixia, Yu Yonghua, Wang Jialin, Sun Xindong, Yang Guoren, Wang Yongzheng

机构信息

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China.

出版信息

Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):727-34. doi: 10.1016/j.ijrobp.2006.08.057.

DOI:10.1016/j.ijrobp.2006.08.057

PMID:17293231

Abstract

PURPOSE

To determine the optimal clinical target volume (CTV) margins around the nodal gross tumor volume (GTV) in non-small-cell lung cancer (NSCLC) patients by assessing microscopic tumor extension beyond regional lymph node capsules.

METHODS AND MATERIALS

The incidence of nodal extracapsular extension (ECE) and relationship with nodal size were reviewed in 243 patients. Histologic sections of dissected regional lymph nodes up to 30 mm in size were examined to measure the extent of microscopic ECE. We determined the distribution of cases according to extent of ECE and the relationships between ECE extent and lymph node size, regional nodal disease extent, histologic type, and degree of differentiation.

RESULTS

The nodal ECE was seen in 41.6% of patients (101/243) and 33.4% of lymph nodes (214/640), and the incidence correlated to larger lymph node size positively. The extent of ECE was 0.7 mm in mean (range, 0-12.0 mm) and <or=3 mm in 95% of the nodes. Positive correlations were found between extent of ECE and larger lymph node size (>or=20 mm vs. 10-19 mm or <10 mm, p = 0.005), advanced nodal stage (N2 vs. N1, p = 0.046), and moderate or poor (vs. good or unknown) nodal differentiation (p = 0.002). ECE did not differ significantly by histologic type or nodal station.

CONCLUSIONS

The incidence of ECE related to lymph node size, and ECE extent related to lymph node size, stage, and differentiation. It may be reasonable to recommend 3-mm CTV margins for pathologic lymph nodes <20 mm and more generous margins for lymph nodes >or=20 mm.

摘要

目的

通过评估区域淋巴结包膜外的微观肿瘤扩展情况，确定非小细胞肺癌（NSCLC）患者区域淋巴结大体肿瘤体积（GTV）周围的最佳临床靶体积（CTV）边界。

方法与材料

回顾性分析243例患者的淋巴结包膜外扩展（ECE）发生率及其与淋巴结大小的关系。对切除的最大直径达30 mm的区域淋巴结进行组织学切片检查，以测量微观ECE的范围。我们根据ECE范围以及ECE范围与淋巴结大小、区域淋巴结病变范围、组织学类型和分化程度之间的关系来确定病例分布情况。

结果

41.6%（101/243）的患者出现淋巴结ECE，33.4%（214/640）的淋巴结出现ECE，其发生率与较大的淋巴结大小呈正相关。ECE的平均范围为0.7 mm（范围0 - 12.0 mm），95%的淋巴结ECE范围≤3 mm。ECE范围与较大的淋巴结大小（≥20 mm 对比 10 - 19 mm 或<10 mm，p = 0.005）、晚期淋巴结分期（N2 对比 N1，p = 0.046）以及中等或低分化（对比高分化或未知分化，p = 0.002）呈正相关。ECE在组织学类型或淋巴结部位方面无显著差异。