Department of Thoracic Surgery, Hyogo Cancer Center for Adults, Akashi, Japan.
Surg Today. 2010 May;40(5):428-32. doi: 10.1007/s00595-008-4072-4. Epub 2010 Apr 28.
The preoperative assessment of nodal status in lung cancer is complicated and problematic for physicians and surgeons. Although many patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) are candidates for surgical treatment, these patients represent a heterogeneous subgroup with unpredictable survival. We conducted this study to evaluate the surgical results of cN1 disease and to attempt to clarify the delicate issues surrounding its diagnosis and prognosis.
The subjects of this study were 187 consecutive patients with cN1 adenocarcinoma or squamous cell carcinoma of the lung, who underwent complete resection without induction therapy.
Only 25% of the adenocarcinomas and 54% of the squamous cell carcinomas were correctly diagnosed as N1 disease preoperatively. Multiple logistic regression analyses revealed that adenocarcinoma (P = 0.0141) was a significant predictor of pN2. Multivariate analyses revealed that nodal metastasis (P < 0.0001), large tumor size (P = 0.0079), and high serum carcinoembryonic antigen value (P = 0.0096) were significantly poor prognostic factors in cN1 patients.
It is difficult to diagnose nodal status in patients with cN1 disease, which requires various surgical procedures, including plasty, possibly with adjuvant therapy in a defined high-risk subgroup.
肺癌淋巴结状态的术前评估对医生和外科医生来说既复杂又棘手。尽管许多临床 N1（cN1）非小细胞肺癌（NSCLC）患者是手术治疗的候选者，但这些患者代表了一个具有不可预测生存的异质亚组。我们进行这项研究旨在评估 cN1 疾病的手术结果，并尝试阐明其诊断和预后所涉及的微妙问题。
本研究的对象是 187 例连续接受完全切除而无诱导治疗的 cN1 腺癌或鳞状细胞癌患者。
仅 25%的腺癌和 54%的鳞状细胞癌术前被正确诊断为 N1 疾病。多变量逻辑回归分析显示，腺癌（P = 0.0141）是 pN2 的显著预测因子。多变量分析显示，淋巴结转移（P < 0.0001）、大肿瘤大小（P = 0.0079）和高血清癌胚抗原值（P = 0.0096）是 cN1 患者的显著不良预后因素。
cN1 疾病的淋巴结状态难以诊断，需要进行各种手术程序，包括整形术，并可能在定义的高危亚组中进行辅助治疗。
