Muraoka Masashi, Akamine Shinji, Oka Tadayuki, Tagawa Tsutomu, Nakamura Akihiro, Tsuchiya Tomoshi, Hayashi Tomayoshi, Nagayasu Takeshi
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Eur J Cardiothorac Surg. 2007 Aug;32(2):356-61. doi: 10.1016/j.ejcts.2007.04.030. Epub 2007 May 21.
It is controversial whether a systematic mediastinal lymph node dissection (MLND) needs to be performed in all patients with stage I lung cancer. The present study was done to examine the new sentinel lymph nodes hypothesis based on the lobe of the primary tumor.
In our first study, the lymph node (LN) metastases were assessed in 291 stage I non-small cell lung cancer (NSCLC) patients who had a major lung resection with a systematic mediastinal lymph node dissection. We evaluated the validity of using our new sentinel lymph nodes method based on the lobe of the primary tumor as follows: the pretracheal (#3), tracheobronchial (#4), and hilar nodes (#10) for right upper lobe tumors; #4, subcarinal (#7), and #10 for middle lobe tumors; the subaortic (#5), paraaortic (#6), and #10 for left upper lobe tumors; and the #7, #10, and interlobar nodes (#11) for tumors in either lower lobes. In the second study, we performed a lobectomy with new sentinel node sampling in 64 patients with preoperative complications. If all of the sampling nodes showed no metastases on frozen section diagnosis, systematic node dissections were not performed.
Six of 291 patients in the first study had skip metastases that did not involve the new sentinel nodes; 5 of the 6 patients had macroscopic pleural invasion. Thus, we defined pleural invasion as an exclusion criterion for the second study. In the second study, the median follow-up time was 39 months. Metastatic lymph nodes were detected in 11 of 64 patients. Fifty-three patients (83%) had no metastasis in the sampled nodes, and, therefore, a mediastinal lymph node dissection was not done. The morbidity rate in the sampling group was 36%, and there was no mortality. In the sampling group, local recurrences were observed in two patients, distant metastases in eight, and carcinomatous pleuritis in one; the overall 5-year survival rate was 82%.
We found that it is possible to perform a less invasive lymphadenectomy for patients with stage I lung cancer using intra-operative sampling of new sentinel lymph nodes.
对于所有I期肺癌患者是否均需行系统性纵隔淋巴结清扫术（MLND）存在争议。本研究旨在基于原发肿瘤所在肺叶检验新的前哨淋巴结假说。
在我们的第一项研究中，对291例行肺大部切除术并系统性纵隔淋巴结清扫术的I期非小细胞肺癌（NSCLC）患者的淋巴结转移情况进行了评估。我们评估了基于原发肿瘤所在肺叶采用新的前哨淋巴结方法的有效性，具体如下：右上叶肿瘤的气管前淋巴结（#3）、气管支气管淋巴结（#4）和肺门淋巴结（#10）；中叶肿瘤的#4、隆突下淋巴结（#7）和#10；左上叶肿瘤的主动脉弓下淋巴结（#5）、主动脉旁淋巴结（#6）和#10；下叶肿瘤的#7、#10和叶间淋巴结（#11）。在第二项研究中，我们对64例有术前并发症的患者行新前哨淋巴结采样的肺叶切除术。如果所有采样淋巴结在冰冻切片诊断中均未发现转移，则不行系统性淋巴结清扫术。
第一项研究中的291例患者中有6例存在跳跃转移，未累及新的前哨淋巴结；6例患者中有5例有肉眼可见的胸膜侵犯。因此，我们将胸膜侵犯定义为第二项研究的排除标准。在第二项研究中，中位随访时间为39个月。64例患者中有11例检测到转移淋巴结。53例患者（83%）采样淋巴结无转移，因此未行纵隔淋巴结清扫术。采样组的发病率为36%，无死亡病例。在采样组中，2例患者出现局部复发，8例出现远处转移，1例出现癌性胸膜炎；总体5年生存率为82%。
我们发现，对于I期肺癌患者，使用术中采样新的前哨淋巴结进行侵入性较小的淋巴结切除术是可行的。
