Takamochi K, Oh S, Suzuki K
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Thorac Cardiovasc Surg. 2010 Sep;58(6):345-9. doi: 10.1055/s-0030-1249944. Epub 2010 Sep 7.
The purpose of this study was to evaluate the new lymph node map proposed by the International Association for the Study of Lung Cancer (IASLC) from the point of prognosis, and to identify the significant prognostic factors in each pathological N stage.
We reviewed 647 consecutive patients with surgically resected non-small cell lung cancers. Survival was analyzed according to N stage and three prognostic subgroups: N1a (single N1 zone), N1b (multiple N1 zones) or N2a (single N2 zone), and N2b (multiple N2 zones). The following prognostic factors were evaluated for each N stage: location of involved zones, number of involved lymph nodes, stations and zones, and the presence of skip metastases.
(1) The survival curves showed a stepwise deterioration as the N stage increased. (2) No significant difference was observed in survival between the different locations of involved zones in each N stage. (3) In N2 patients, the presence of skip metastases was a significant prognostic factor in multivariate analysis.
The proposed IASLC map is valid for prognostic stratification. The prognostic impact of the presence of skip metastases on N2 disease should therefore be taken into consideration when carrying out the forthcoming revision of the TNM staging system.
本研究旨在从预后角度评估国际肺癌研究协会（IASLC）提出的新淋巴结图谱，并确定各病理N分期中的显著预后因素。
我们回顾了647例连续接受手术切除的非小细胞肺癌患者。根据N分期和三个预后亚组进行生存分析：N1a（单个N1区）、N1b（多个N1区）或N2a（单个N2区）以及N2b（多个N2区）。对每个N分期评估以下预后因素：受累区域的位置、受累淋巴结的数量、站别和区域，以及跳跃转移的存在情况。
（1）生存曲线显示随着N分期增加呈逐步恶化。（2）在每个N分期中，受累区域的不同位置之间未观察到生存差异。（3）在N2患者中，跳跃转移的存在在多因素分析中是一个显著的预后因素。
IASLC提出的图谱对预后分层有效。因此，在即将进行的TNM分期系统修订时，应考虑跳跃转移对N2期疾病预后的影响。
