Ma Kai, Chang Dong, He Baoliang, Gong Min, Tian Feng, Hu Xiaodan, Ji Zhongyi, Wang Tianyou
Department of Thoracic and Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
J Cancer Res Clin Oncol. 2008 Dec;134(12):1289-95. doi: 10.1007/s00432-008-0421-3. Epub 2008 May 27.
To explore the appropriate method of mediastinal lymph node dissection for selected clinical stage IA (cIA) non-small cell lung cancer (NSCLC).
From 1998 through 2002, the curative-intent surgery was performed to 105 patients with cIA NSCLC who had been postoperatively identified as pathologic-stage T1. According to the method of intraoperative medistinal lymph node dissection, they were divided into radical systematic mediastinal lymphadenectomy (LA) group (n = 42) and mediastinal lymph-node sampling (LS) group (n = 63). The effects of LS and LA on morbidity, N staging, overall survival (OS) and disease-free survival (DFS) were investigated. Also, associations between clinicopathological parameters and survival were analyzed.
The mean numbers of dissected lymph nodes per patient in the LA group was significantly greater than that in the LS group (15.59 +/- 3.08 vs. 6.46 +/- 2.21, P < 0.001), and the postoperative overall morbidity rate was higher in the LA group than that in the LS group (26.2 vs. 11.1%, P = 0.045). There were no significant difference in migration of N staging, OS and DFS between two groups. However, for patients with lesions between 2 and 3 cm, the 5-year OS in LA group was significantly higher than that in LS group (81.6 vs. 55.8%, P = 0.041), and the 5-year DFS was also higher (77.9 vs. 52.5%, P = 0.038). For patients with lesions of 2 cm or less, 5-year OS and DFS were similar in both groups. Multivariate analysis showed that lymph node metastasis was the unique unfavorable prognostic factor (P < 0.001).
After being intraoperatively identified as stage T1, patients with lesions between 2 and 3 cm in cIA NSCLC should be performed with LA to get a potentially better survival, and patients with lesions of 2 cm or less should be performed with LS to decrease invasion.
探讨针对特定临床分期IA（cIA）非小细胞肺癌（NSCLC）的纵隔淋巴结清扫的合适方法。
1998年至2002年，对105例术后病理分期为T1的cIA NSCLC患者进行了根治性手术。根据术中纵隔淋巴结清扫方法，将他们分为根治性系统性纵隔淋巴结清扫术（LA）组（n = 42）和纵隔淋巴结采样术（LS）组（n = 63）。研究了LS和LA对发病率、N分期、总生存期（OS）和无病生存期（DFS）的影响。此外，分析了临床病理参数与生存期之间的关联。
LA组患者平均清扫淋巴结数显著多于LS组（15.59±3.08对6.46±2.21，P < 0.001），且LA组术后总发病率高于LS组（26.2%对11.1%，P = 0.045）。两组在N分期转移、OS和DFS方面无显著差异。然而，对于肿瘤大小在2至3 cm之间的患者，LA组的5年OS显著高于LS组（81.6%对55.8%，P = 0.041），5年DFS也更高（77.9%对52.5%，P = 0.038）。对于肿瘤大小在2 cm及以下的患者，两组的5年OS和DFS相似。多因素分析显示淋巴结转移是唯一不利的预后因素（P < 0.001）。
cIA NSCLC患者术中确诊为T1期，肿瘤大小在2至3 cm之间的应行LA以获得潜在更好的生存期，肿瘤大小在2 cm及以下的应行LS以减少侵袭。
