Division of Thoracic Surgery, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan.
J Thorac Oncol. 2010 Apr;5(4):504-9. doi: 10.1097/JTO.0b013e3181ccb391.
Lymph node involvement is one of the most important prognostic factors in cancer patients. It is categorized based on the anatomic extent, but differences in node involvement patterns are not incorporated in the tumor, node, metastasis classification. Squamous cell carcinoma more frequently arises in the central airway and invades adjacent lymph nodes directly than the other histologic types. The purpose of this study was to evaluate the prognostic impact of lymph node involvement patterns in pulmonary pN1 SCC patients.
We reviewed 120 consecutive patients with completely resected pN1 squamous cell carcinoma and classified them into two groups based on node involvement pattern: direct (all metastatic N1 nodes involved directly by the main tumor) and separate (one or more metastatic N1 nodes not directly involved by the main tumor) N1 groups. To compare the survival probability, 302 pN0 patients and 59 pN2 patients were also investigated.
Univariate and multivariate analyses showed that the N1 node involvement pattern significantly associated with patient prognosis. The direct N1 group resulted in a much better 5-year overall survival rate of 67.7% compared with 32.4% for the separate N1 group (p < 0.01). The direct N1 group survival curve almost overlapped with the pN0 curve (p = 0.68), whereas the separate N1 group curve overlapped with the pN2 curve (p = 0.91).
Direct N1 metastatic cases are highly curable, similar to pN0 patients. In contrast, separate N1 metastatic cases are destined to poor prognosis similar to pN2 patients.
淋巴结受累是癌症患者最重要的预后因素之一。它基于解剖范围进行分类，但肿瘤、淋巴结、转移分类中并未纳入淋巴结受累模式的差异。与其他组织学类型相比，鳞状细胞癌更常发生在中央气道并直接侵犯邻近淋巴结。本研究旨在评估肺 pN1 SCC 患者淋巴结受累模式的预后影响。
我们回顾了 120 例完全切除的 pN1 鳞状细胞癌患者，并根据淋巴结受累模式将其分为两组：直接（所有转移性 N1 淋巴结均由主肿瘤直接累及）和单独（一个或多个转移性 N1 淋巴结未直接由主肿瘤累及）N1 组。为了比较生存概率，还研究了 302 例 pN0 患者和 59 例 pN2 患者。
单因素和多因素分析表明，N1 淋巴结受累模式与患者预后显著相关。直接 N1 组的 5 年总生存率为 67.7%，明显优于单独 N1 组的 32.4%（p<0.01）。直接 N1 组的生存曲线几乎与 pN0 曲线重叠（p=0.68），而单独 N1 组的生存曲线与 pN2 曲线重叠（p=0.91）。
直接 N1 转移病例具有高度可治愈性，与 pN0 患者相似。相比之下，单独的 N1 转移病例预后较差，与 pN2 患者相似。
