Liu Kun, Chen Hong-Lin, You Qing-Sheng, Huang Jian-Fei, Wang Hua
Department of Medicine, Nanjing University, Nanjing, Jiangsu, 210093, People's Republic of China.
Ai Zheng. 2009 Jul;28(7):725-9. doi: 10.5732/cjc.008.10849.
Clinical characteristics of skip N2 metastasis of stage IIIA non-small cell lung cancer (NSCLC) are not clear. This study was to investigate the clinicopathologic features and the distribution pattern of N2 lymph nodes, thus to analyze the relationship between the survival rate and skip metastasis of NSCLC patients.
Clinical data of 292 patients with stage IIIA NSCLC undergoing radical surgical resection plus mediastinal nodal dissection in the Affiliated Hospital of Nantong University were retrospectively reviewed. Clinicopathologic features, distribution of skip N2 metastasis and survival were analyzed respectively.
The incidence rate of skip N2 metastasis in stage IIIA NSCLC patients was 15.8%, which was correlated to the size of the tumor (P<0.05). Moreover, the relationship between the primary tumor location and N2 positive lymph nodes were described as follows: right upper lobe cancer displayed skip-N2 nodal metastasis mostly in the 3rd and 4th station (85.7%), right middle lobe mostly in the 7th station(75.0%), right lower lobe mostly in the 3rd and 7th station(81.0%), left upper lobe mostly in the 5th and 6th station(80.0%), and left lower lobe mostly in the 7th station (65.0%). The 3-year survival rate of patients with skip N2 metastasis was 45.4%, compared to 29.5% in patients with the involvement of N1 and N2 nodes. Survival analysis showed that skip N2 metastasis was an independent risk factor of stage IIIA NSCLC in addition to tumor size, histology, type of resection, adjuvant chemotherapy and radiotherapy.
In stage IIIA NSCLC, primary tumors in different locations have their own corresponding areas of N2 nodal metastasis. Skip N2 metastasis is an independent prognostic factor for the survival of NSCLC. Patients with skip N2 metastasis have a favorable outcome.
ⅢA期非小细胞肺癌（NSCLC）跳跃式N2转移的临床特征尚不清楚。本研究旨在探讨其临床病理特征及N2淋巴结的分布模式，进而分析NSCLC患者生存率与跳跃式转移之间的关系。
回顾性分析南通大学附属医院292例行根治性手术切除加纵隔淋巴结清扫的ⅢA期NSCLC患者的临床资料。分别分析临床病理特征、跳跃式N2转移的分布及生存情况。
ⅢA期NSCLC患者跳跃式N2转移的发生率为15.8%，与肿瘤大小相关（P<0.05）。此外，原发肿瘤部位与N2阳性淋巴结的关系如下：右上叶癌跳跃式N2淋巴结转移多位于第3和第4组（85.7%），右中叶多位于第7组（75.0%），右下叶多位于第3和第7组（81.0%），左上叶多位于第5和第6组（80.0%），左下叶多位于第7组（65.0%）。跳跃式N2转移患者的3年生存率为45.4%，而N1和N2淋巴结均受累患者的3年生存率为29.5%。生存分析显示，除肿瘤大小、组织学类型、切除方式、辅助化疗和放疗外，跳跃式N2转移是ⅢA期NSCLC的独立危险因素。
在ⅢA期NSCLC中，不同部位的原发肿瘤有其相应的N2淋巴结转移区域。跳跃式N2转移是NSCLC生存的独立预后因素。跳跃式N2转移患者预后较好。
