Lee Yung-Chie, Wu Chen-Tu, Kuo Shuenn-Wen, Tseng Yu-Ting, Chang Yih-Leong
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
Chest. 2007 Apr;131(4):993-9. doi: 10.1378/chest.06-1810.
Regional lymph node (LN) involvement affects the prognosis of patients with surgically resected non-small cell lung cancer (NSCLC). The significance of extranodal extension in these groups of patients was prospectively studied to determine its clinicopathologic relationships and its influence on patient survival.
A total of 199 NSCLC patients who were proved to have regional LN involvement after resection were included. Histologic examinations including tumor cell type, grade of differentiation, vascular invasion, regional LN metastasis emphasizing the number and station of LN involvement, the presence or absence of extranodal extension, and the immunohistochemistry of p53 expression were obtained. The relationships between extranodal extension and histologic type, grade of differentiation, vascular invasion, tumor size, pathologic stage, p53 expression, or patient survival were analyzed.
Extranodal extension was significantly higher in women, adenocarcinoma, advanced stage, tumors with vascular invasion, or p53 overexpression. The total number and positive rate of resected LNs with extranodal extension were significantly correlated with advanced stage, tumors with vascular invasion, or p53 overexpression. By multivariate analysis of survival, the presence or total number of LNs with extranodal extension, tumor stage, and p53 expression were significant prognostic factors. The 5-year survival rate of stage IIIA patients without extranodal extension (30.4%) was significantly better than that of stage II patients with extranodal extension (16.8%). No survival difference between extranodal positive stage II and IIIA patients was noted.
Extranodal extension of regional LNs is an important prognostic factor in patients with surgically resected NSCLC.
区域淋巴结（LN）受累影响手术切除的非小细胞肺癌（NSCLC）患者的预后。前瞻性研究这些患者组中结外扩展的意义，以确定其临床病理关系及其对患者生存的影响。
纳入199例经切除后证实有区域LN受累的NSCLC患者。进行组织学检查，包括肿瘤细胞类型、分化程度、血管侵犯、区域LN转移，重点关注LN受累的数量和部位、结外扩展的有无以及p53表达的免疫组化。分析结外扩展与组织学类型、分化程度、血管侵犯、肿瘤大小、病理分期、p53表达或患者生存之间的关系。
结外扩展在女性、腺癌、晚期、有血管侵犯的肿瘤或p53过表达患者中显著更高。有结外扩展的切除LN总数和阳性率与晚期、有血管侵犯的肿瘤或p53过表达显著相关。通过生存的多因素分析，有结外扩展的LN的存在或总数、肿瘤分期和p53表达是显著的预后因素。无结外扩展的IIIA期患者的5年生存率（30.4%）显著高于有结外扩展的II期患者（16.8%）。结外阳性的II期和IIIA期患者之间未观察到生存差异。
区域LN的结外扩展是手术切除的NSCLC患者的重要预后因素。
