Veeramachaneni Nirmal K, Battafarano Richard J, Meyers Bryan F, Zoole Jennifer Bell, Patterson G Alexander
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, United States.
Eur J Cardiothorac Surg. 2008 Mar;33(3):466-9. doi: 10.1016/j.ejcts.2007.12.015. Epub 2008 Jan 31.
The application of CT imaging has increased the identification of patients with clinical T1N0 (cT1N0) lung cancer. The optimal management strategy for these early stage lung cancers remains unclear. We analyzed the impact of occult nodal metastasis on cT1N0 lung cancer patients.
We studied patients with cT1N0 lung cancer enrolled in our database from January 1995 to December 2002. Preoperative staging was confirmed by review of CT and PET scan studies. Pathology specimens were reviewed. Multivariate analysis was performed to determine the risk of occult nodal involvement. Kaplan-Meier method was applied to analyze survival.
Two hundred and ninety-seven patients with cT1N0 disease were identified. Fifty-eight percent of patients were pathological T1N0. Overall, 15% of patients had occult nodal metastasis. Logistic regression analysis demonstrated a three-fold increase in the risk of having pathologic stage II or stage III disease with every 1.0 cm increase in tumor size (odds ratio 3.2; 95% CI: 2.3-4.6). Multivariate analysis demonstrated tumor size to be a significant predictor of nodal metastasis (adjusted odds ratio 3.5; 95% CI: 2.4-5.1). Median survival was different between pathological stage I (96.3 months), stage II (41.4 months), and stage III (36.1 months) disease (p=0.002).
Clinical T1N0 tumors are often understaged. The risk of occult nodal disease increases with tumor size, and this occult disease negatively impacts survival. Because of the limitations of clinical staging, we believe that lobectomy and lymph node analysis should be offered to cT1N0 lung cancer patients to provide accurate staging and to optimize multimodality adjuvant treatment of lung cancer.
CT成像技术的应用增加了临床T1N0（cT1N0）肺癌患者的识别。这些早期肺癌的最佳管理策略仍不明确。我们分析了隐匿性淋巴结转移对cT1N0肺癌患者的影响。
我们研究了1995年1月至2002年12月纳入我们数据库的cT1N0肺癌患者。通过回顾CT和PET扫描研究确认术前分期。对病理标本进行了复查。进行多变量分析以确定隐匿性淋巴结受累的风险。应用Kaplan-Meier方法分析生存率。
共识别出297例cT1N0疾病患者。58%的患者为病理T1N0。总体而言，15%的患者有隐匿性淋巴结转移。逻辑回归分析表明，肿瘤大小每增加1.0 cm，病理分期为II期或III期疾病的风险增加三倍（比值比3.2；95%CI：2.3-4.6）。多变量分析表明肿瘤大小是淋巴结转移的重要预测因素（调整后比值比3.5；95%CI：2.4-5.1）。病理I期（96.3个月）、II期（41.4个月）和III期（36.1个月）疾病的中位生存期不同（p=0.002）。
临床T1N0肿瘤常常分期过低。隐匿性淋巴结疾病的风险随肿瘤大小增加，且这种隐匿性疾病对生存率有负面影响。由于临床分期的局限性，我们认为应向cT1N0肺癌患者提供肺叶切除术和淋巴结分析，以提供准确分期并优化肺癌的多模式辅助治疗。
