Watanabe Shun-ichi, Asamura Hisao, Suzuki Kenji, Tsuchiya Ryosuke
Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2005 Apr;4(2):106-9. doi: 10.1510/icvts.2004.098814. Epub 2005 Jan 27.
A new strategy for selective nodal dissection in non-small cell lung cancer (NSCLC) patients according to the segment of primary tumor was explored. Data on 504 patients with NSCLC of less than 5 cm, histologically revealed to be N2 disease after thoracotomy, were analyzed. In right upper lobe (RUL) tumor, when the pretracheal node was negative, the incidence of subcarinal involvement was 3.8%. In lower lobe tumor, superior segment (RLL-Superior and LLL-Superior) tumor showed a significantly higher incidence of superior mediastinal involvement than basal segment (RLL-Basal and LLL-Basal) tumor (right, P=0.0036; left, P=0.0499). When the subcarinal node was negative, the incidence of superior mediastinal metastasis in RLL-basal and LLL-Basal tumor was 11% and 8%, respectively. In left upper lobe tumor, superior segment (LUL-Superior) tumor showed a significantly lower incidence of subcarinal involvement than lingular segment (LUL-Lingular) tumor (P=0.0381). When aortic nodes were negative in LUL-Superior tumor, the incidence of subcarinal metastasis was 6%. Collectively, in RUL and LUL-Superior tumors, subcarinal dissection may be unnecessary if superior mediastinal node is negative. In RLL-Superior and LLL-Superior tumors, extensive dissection is required. In RLL-Basal and LLL-Basal tumors, superior mediastinal dissection may be unnecessary if subcarinal node is negative.
探索了一种根据原发性肿瘤部位对非小细胞肺癌（NSCLC）患者进行选择性淋巴结清扫的新策略。分析了504例肿瘤直径小于5 cm的NSCLC患者的数据，这些患者经开胸手术组织学检查显示为N2期疾病。在右上叶（RUL）肿瘤中，当气管前淋巴结为阴性时，隆突下受累的发生率为3.8%。在下叶肿瘤中，上叶段（右肺下叶上叶段和左肺下叶上叶段）肿瘤的上纵隔受累发生率显著高于基底段（右肺下叶基底段和左肺下叶基底段）肿瘤（右侧，P = 0.0036；左侧，P = 0.0499）。当隆突下淋巴结为阴性时，右肺下叶基底段和左肺下叶基底段肿瘤的上纵隔转移发生率分别为11%和8%。在左上叶肿瘤中，上叶段（左肺上叶上叶段）肿瘤的隆突下受累发生率显著低于舌叶段（左肺上叶舌叶段）肿瘤（P = 0.0381）。当左肺上叶上叶段肿瘤的主动脉旁淋巴结为阴性时，隆突下转移的发生率为6%。总体而言，在RUL和左肺上叶上叶段肿瘤中，如果上纵隔淋巴结为阴性，可能无需进行隆突下清扫。在右肺下叶上叶段和左肺下叶上叶段肿瘤中，需要进行广泛清扫。在右肺下叶基底段和左肺下叶基底段肿瘤中，如果隆突下淋巴结为阴性，可能无需进行上纵隔清扫。
