Division of Hematology/Medical Oncology, University of Tennessee Health Sciences Center, Memphis, Tennessee 38104, USA.
J Thorac Oncol. 2010 Feb;5(2):191-6. doi: 10.1097/JTO.0b013e3181c8cc32.
Metastasis to lymph nodes (LNs) connotes poor prognosis in non-small cell lung cancer (NSCLC). Sufficient LNs must be examined to accurately determine LN negativity. Patients with no LNs examined (pNx) have an indeterminate stage, may have undetected disease and erroneous assignment to a low-risk group. To evaluate this possibility, we compared the survival of patients with node-negative disease and at least one LN examined (pN0) to those with pNx.
Retrospective analysis of all resections for NSCLC from January 1, 2004 to December 31, 2007 at hospitals in the Memphis Metropolitan Area.
Of 746 resections, 90 (12.1%) were Nx; 506 (67.8%) N0. Demographic and histologic characteristics were similar. A total of 54.4% Nx patients had sublobar resection, compared with 5.5% N0 (p < 0.0001). In the N0 cohort, the median (range) number of LNs was 5 (1-45); N1 LNs, 3 (0-38); N2 LNs, 1 (0-29); 35.4% had no mediastinal LNs examined; 9.1% had only mediastinal LNs. Eighty- five percent of N0 patients had less than 10 LNs. The 3-year survival estimate for the T1NxM0 versus T1N0M0 patients was 70% versus 79% (p = 0.17); for T2NxM0 versus T2N0M0, it was 25% versus 65% (p < 0.01).
A high percentage of patients undergoing surgical resection for NSCLC have no LNs examined, most of these patients have had sublobar resection. Majority with node-negative disease have fewer than 10 LNs, a large proportion have no mediastinal LNs, raising the possibility of understaging. Patients with pT2Nx do significantly worse than those with pT2N0.
淋巴结转移（LNs）提示非小细胞肺癌（NSCLC）预后不良。为了准确判断淋巴结阴性，必须充分检查淋巴结。未检查淋巴结（pNx）的患者分期不确定，可能存在未被发现的疾病，并被错误地归入低风险组。为了评估这种可能性，我们比较了淋巴结阴性疾病且至少检查一个淋巴结（pN0）与 pNx 患者的生存情况。
回顾性分析 2004 年 1 月 1 日至 2007 年 12 月 31 日在孟菲斯都会区医院进行的所有 NSCLC 切除术。
746 例切除术中有 90 例（12.1%）为 Nx；506 例（67.8%）为 N0。人口统计学和组织学特征相似。Nx 患者中有 54.4%行亚肺叶切除术，而 N0 患者为 5.5%（p<0.0001）。在 N0 组中，中位数（范围）淋巴结数为 5（1-45）；N1 淋巴结为 3（0-38）；N2 淋巴结为 1（0-29）；35.4%未检查纵隔淋巴结；9.1%仅检查纵隔淋巴结。85%的 N0 患者淋巴结少于 10 个。T1NxM0 与 T1N0M0 患者的 3 年生存率估计值分别为 70%和 79%（p=0.17）；T2NxM0 与 T2N0M0 患者分别为 25%和 65%（p<0.01）。
接受 NSCLC 手术切除的患者中，有相当大比例的患者未检查淋巴结，其中大多数患者行亚肺叶切除术。大多数淋巴结阴性疾病患者的淋巴结少于 10 个，很大一部分患者没有纵隔淋巴结，这可能导致分期不足。pT2Nx 患者的预后明显差于 pT2N0 患者。
