Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Department of Third Thoracic Surgery, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2010 Feb;37(2):446-50. doi: 10.1016/j.ejcts.2009.07.021. Epub 2009 Aug 22.
Complete resection is the therapy of choice in non-small-cell lung cancer (NSCLC). There is no agreement on the type of resection, especially when interlobar N1 disease is present. The present study explored the effect of the type of resection on survival in the presence of N1 disease.
Medical records of 195 patients with NSCLC who underwent resection between 1998 and 2006 and whose histopathological examination showed N1 disease were reviewed retrospectively. This study included 162 patients with T status of T1, T2 or T3, who had complete resection (excluding superior sulcus tumours). The patients were divided into three groups, namely hilar N1 (n=15, 9.3%), interlobar N1 (N1-i) (n=54, 33.3%) and lobar N1 (n=93, 57.4%). Frequency comparisons were carried out by chi-square test. Survival rates were calculated by the Kaplan-Meier method and compared by log-rank test after patients who had operative mortality (n=10, 6.2%) were excluded.
Seventy-seven patients (47.5%) had lobectomy, 14 (8.6%) had bilobectomy (BL) and 71 (43.8%) had pneumonectomy (PN). Twenty-one of these patients (13.0%) had sleeve lobectomy and 19 had (11.7%) additional interventions (such as resection of the diaphragm or thoracic wall). Among all N1 patients, 5-year survival rate was 56.9% in patients who had BL or PN and 46.8% in patients who had lobectomy, a difference not statistically significant (p=0.09). Similarly, there was no significant difference between patients who had sleeve resection and PN (p=0.58). The type of resection was not found related to survival in the presence of interlobar (p=0.75). Similarly, type of resection was not significantly associated with survival in patients with hilar N1 (p=0.86).
Those who had PN or BL had a higher survival rate, which was statistically insignificant. Further studies are required to determine whether or not the type of resection should be changed as a result of N1 only.
非小细胞肺癌（NSCLC）的治疗方法以完全切除为主。对于存在肺门淋巴结 N1 转移的患者，尚没有达成一致的手术方式选择。本研究旨在探讨存在 N1 转移时，不同手术方式对患者生存的影响。
回顾性分析了 1998 年至 2006 年间接受手术治疗且术后病理证实存在淋巴结 N1 转移的 195 例 NSCLC 患者的病历资料。本研究纳入了 T 分期为 T1、T2 或 T3 的 162 例患者，这些患者均接受了完全切除（不包括上沟瘤）。根据淋巴结转移部位的不同，将患者分为三组：肺门淋巴结 N1 组（15 例，9.3%）、叶间淋巴结 N1 组（54 例，33.3%）和肺段淋巴结 N1 组（93 例，57.4%）。采用卡方检验进行频率比较，排除术后发生死亡（10 例，6.2%）的患者后，采用 Kaplan-Meier 法计算生存率，并采用对数秩检验进行比较。
77 例（47.5%）患者接受了肺叶切除术，14 例（8.6%）患者接受了双肺叶切除术（BL），71 例（43.8%）患者接受了肺切除术（PN）。21 例患者接受了袖状肺叶切除术，19 例患者接受了其他辅助治疗（如膈肌或胸壁切除术）。在所有 N1 患者中，BL 或 PN 组患者的 5 年生存率为 56.9%，肺叶切除术组患者的 5 年生存率为 46.8%，差异无统计学意义（p=0.09）。同样，接受袖状肺叶切除术与 PN 治疗的患者之间的生存率差异也无统计学意义（p=0.58）。叶间淋巴结 N1 组患者的手术方式与生存率也无明显相关性（p=0.75）。
PN 或 BL 组患者的生存率较高，但差异无统计学意义。需要进一步研究以确定是否应根据 N1 情况改变手术方式。
