Zhong Wenzhao, Yang Xuening, Bai Jianling, Yang Jinji, Manegold Christian, Wu Yilong
Lung Cancer Research Institute and Cancer Center, Guangdong Provincial People's Hospital, Guangzhou, China.
Eur J Cardiothorac Surg. 2008 Jul;34(1):187-95. doi: 10.1016/j.ejcts.2008.03.060. Epub 2008 May 23.
There is a great deal of concern about metastasis of lung cancer to regional lymph nodes, due partly to the work of groups of thoracic surgeons in Japan and North America beginning in the 1970s. The classification of regional lymph node stations for lung cancer staging published by Mountain and Dresler has been widely adopted for more than ten years. Anatomic landmarks for 14 levels of intrapulmonary, hilar, and mediastinal lymph nodes stations are designated. Skip transfer and occult lymph node metastasis, confirmed by studies regarding the mode of spread of intrathoracic lymphatic metastasis, are two theoretical bases for complete mediastinal lymphadenectomy of lung cancer. However, whether or not the degree of the dissection influences prognosis, the role of systematic nodal dissection (SND) vs mediastinal lymph node sampling (MLD) in resectable non-small cell lung cancer (NSCLC) remains controversial. A systematic literature search was performed to identify relevant reports, making full use of the 'Cited by,' 'Related Records,' 'References,' and 'Author Index' functions in the PubMed and ISI Web of Science databases. This paper presents a review of the role of mediastinal lymph node distribution and methods of determining suitability for hilar and mediastinal lymphadenectomy based on the four subsets of stage IIIA-N2, balancing the cost vs effect of mediastinal lymph node dissection in resectable NSCLC, focusing on the stage migration bias in clinical trials comparing SND and MLS, recommending a reasonable node dissection sequence, improving the prospects for the perioperative anti-tumor therapy based on mediastinal lymphadenectomy, and evaluating the various preoperative staging techniques. Finally, we believe that, besides the role of complete resection and accurate staging, the complete mediastinal lymphadenectomy is the core component of the lung cancer multidisciplinary therapy, and suggest that the values of lymphadenectomy should be further assessed using decision-tree analysis based on large-scale prospective randomized trials and pooled analysis to evaluate the costs vs effects.
人们对肺癌转移至区域淋巴结极为关注，部分原因是20世纪70年代起日本和北美的胸外科医生团队开展的工作。Mountain和Dresler发布的用于肺癌分期的区域淋巴结站分类已被广泛采用十余年。指定了肺内、肺门和纵隔淋巴结站14个级别的解剖标志。经关于胸内淋巴转移传播方式的研究证实的跳跃转移和隐匿性淋巴结转移，是肺癌完全纵隔淋巴结清扫术的两个理论基础。然而，无论清扫程度是否影响预后，可切除的非小细胞肺癌（NSCLC）中系统性淋巴结清扫（SND）与纵隔淋巴结采样（MLD）的作用仍存在争议。进行了系统的文献检索以识别相关报告，充分利用了PubMed和ISI Web of Science数据库中的“被引用文献”“相关记录”“参考文献”和“作者索引”功能。本文综述了纵隔淋巴结分布的作用以及基于IIIA-N2期四个亚组确定肺门和纵隔淋巴结清扫术适用性的方法，权衡可切除NSCLC中纵隔淋巴结清扫的成本与效果，关注比较SND和MLS的临床试验中的分期迁移偏倚，推荐合理的淋巴结清扫顺序，改善基于纵隔淋巴结清扫术的围手术期抗肿瘤治疗前景，并评估各种术前分期技术。最后，我们认为，除了完全切除和准确分期的作用外，完全纵隔淋巴结清扫术是肺癌多学科治疗的核心组成部分，并建议应基于大规模前瞻性随机试验和汇总分析，使用决策树分析进一步评估淋巴结清扫术的价值，以评估成本与效果。
