Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd. 507, Shanghai 200433, China.
Lung Cancer. 2011 Jun;72(3):348-54. doi: 10.1016/j.lungcan.2010.10.003. Epub 2010 Nov 13.
Present research aimed to explore the rationale of defining RIR operations by metastatic status of highest nodes.
549 surgical patients, bearing pN2-NSCLCs, were enrolled in the current study. R1/R2 nodes on the right side and L4 nodes on the left were taken as the highest mediastinal lymph nodes. The operations were defined "Complete Resection (CR)" if the highest nodes were negative. Operations were otherwise "Relative Incomplete Resections (RIR)" if the nodes were positive. Exclusion criteria included: metastatic carcinomas or small cell lung cancer, prior history of induction therapy, exploratory thoracotomy, palliative resection, and massive pleural dissemination, as well as cases without "highest" mediastinal nodal pathology. The survival rate was calculated using the life-table and Kaplan-Meier method. Comparisons between groups were calculated using the Log-rank test.
A total of 6865 lymph nodes (5705 mediastinal and 1160 regional, average 12.6±6.4 nodes for each patient) were removed. Total cases included 246 RIR (100 left and 146 right side) and 303 CR (108 left and 195 right). The overall 5-year survival rate was 22% and the median survival time was 28.29 months. Five-year survival rates of the CR and RIR group were statistically significant (29% and 13%, respectively p<0.0001). L4 and R1/R2 lymph nodes had similar position for defining RIR; no obvious survival difference was indicated between either side (p=0.464 in CR groups, p=0.647 in RIR groups). N2 subcategories and skip-metastasis were closely associated with highest nodal involvement (p<0.0001). Multivariate analysis showed CR/RIR assignment, tumor size, N2 disease stratification, pathological T status, and number of positive mediastinal nodes were risk factors for 5-year survival in the present case series.
Involvement of the highest mediastinal lymph nodes is highly predictive of poor prognosis and indicates an advanced stage of the disease. Therefore, it may be appropriate to assign R1/R2 or L4 as criterion for defining RIR or CR cases in surgical NSCLC cases.
本研究旨在探讨根据最高淋巴结转移状态定义 RIR 手术的原理。
本研究纳入了 549 名接受手术的 pN2-NSCLC 患者。右侧 R1/R2 淋巴结和左侧 L4 淋巴结被视为最高纵隔淋巴结。如果最高淋巴结阴性，则手术定义为“完全切除 (CR)”。如果淋巴结阳性，则手术定义为“相对不完全切除 (RIR)”。排除标准包括：转移性癌或小细胞肺癌、诱导治疗史、探查性剖胸术、姑息性切除术和大量胸膜播散，以及没有“最高”纵隔淋巴结病理的病例。使用寿命表和 Kaplan-Meier 方法计算生存率。使用对数秩检验比较组间差异。
共切除 6865 个淋巴结（5705 个纵隔淋巴结和 1160 个区域淋巴结，每位患者平均 12.6±6.4 个）。总病例包括 246 例 RIR（100 例左侧和 146 例右侧）和 303 例 CR（108 例左侧和 195 例右侧）。总体 5 年生存率为 22%，中位生存时间为 28.29 个月。CR 和 RIR 组的 5 年生存率有统计学差异（分别为 29%和 13%，p<0.0001）。L4 和 R1/R2 淋巴结在定义 RIR 方面具有相似的位置；两侧之间的生存差异无统计学意义（CR 组 p=0.464，RIR 组 p=0.647）。N2 亚组和跳跃转移与最高淋巴结受累密切相关（p<0.0001）。多因素分析显示，CR/RIR 分组、肿瘤大小、N2 疾病分层、病理 T 分期和阳性纵隔淋巴结数量是本病例系列 5 年生存的危险因素。
最高纵隔淋巴结受累高度预测预后不良，表明疾病处于晚期。因此，在手术治疗 NSCLC 时，将 R1/R2 或 L4 作为定义 RIR 或 CR 病例的标准可能是合适的。
