Wu Nan, Yan Shi, Zheng Qing-feng, Lü Chao, Wang Yu-zhao, Wang Jia, Yang Yue
Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100142, China.
Zhonghua Yi Xue Za Zhi. 2010 Jul 20;90(27):1873-6.
To investigate the metastatic rate of segmental and/or sub-segmental lymph nodes and their roles in pathological staging after a major pulmonary resection.
This prospective study recruited 90 cases of pulmonary resection performed at our department from February 2007 to February 2008. Hilar lymph nodes (No. 10), interlobar nodes (No. 11), lobar nodes (No. 12), segmental nodes (No. 13) and subsegmental nodes (No. 14) were resected and their clinic data analyzed.
(1) The median number of total lymph nodes harvested, mediastinal nodes, nodes from No. 10-14 and nodes from No. 13-14 were 29 (11-50), 17 (6-35), 12 (2-26) and 4 (1-17) respectively. Lymph node metastatic rate from No.10, No. 11, No. 12, No. 13 + 14 were 12.2%, 6.7%, 23.3% and 38.9% respectively. (2) Forty-two cases of N0 and 27 cases of N1 were diagnosed in this group. The N1 subgroup included 12 cases of No. 13-14 metastasis solely and 15 cases of No. 10-12 and No. 13-14 metastasis simultaneously. If an analysis of No. 13-14 was omitted, the diagnostic accuracy of N0 could only reach 77.8% and 44.4% cases would be under-staged from N1. (3) In 33 cases of peripheral lung cancers smaller than 3 cm in diameter, 12.1% of metastatic lymph nodes from No.12-13 would be left in the original place if a segmental resection was performed. Similarly, 18.2% of metastatic lymph nodes could be neglected for wedge resection cases.
Metastasis to segmental or subsegmental lymph nodes accounts for a large part of lung cancer patients. Therefore an analysis of these nodes can improve the accuracy of pathological staging. Secondly, limited pulmonary resection needs to follow a strict indication in consideration of the potential metastasis to segmental or subsegmental lymph nodes in peripheral small lung cancers.
探讨肺叶及/或亚肺叶淋巴结转移率及其在肺大切除术后病理分期中的作用。
本前瞻性研究纳入了2007年2月至2008年2月在我科进行肺切除的90例患者。切除肺门淋巴结（第10组）、叶间淋巴结（第11组）、肺叶淋巴结（第12组）、肺段淋巴结（第13组）和亚肺段淋巴结（第14组），并分析其临床资料。
（1）所获淋巴结总数、纵隔淋巴结、第10 - 14组淋巴结及第13 - 14组淋巴结的中位数分别为29枚（11 - 50枚）、17枚（6 - 35枚）、12枚（2 - 26枚）和4枚（1 - 17枚）。第10组、第11组、第12组、第13 + 14组淋巴结转移率分别为12.2%、6.7%、23.3%和38.9%。（2）该组确诊N0 42例，N1 27例。N1亚组中，单纯第13 - 14组转移12例，第10 - 12组与第13 - 14组同时转移15例。若不分析第13 - 14组，N0的诊断准确率仅为77.8%，44.4%的病例N分期会偏低。（3）在33例直径小于3 cm的周围型肺癌中，行肺段切除时，第12 - 13组转移淋巴结有12.1%会残留原位。同样，行楔形切除时，18.2%的转移淋巴结可被忽略。
肺段或亚肺段淋巴结转移在肺癌患者中占很大比例。因此，对这些淋巴结的分析可提高病理分期的准确性。其次，考虑到周围型小肺癌可能存在肺段或亚肺段淋巴结转移，有限性肺切除需严格掌握适应证。
