Thoracic Surgery Division, European Institute of Oncology, Milan, Italy.
Eur J Cardiothorac Surg. 2011 Apr;39(4):e38-43. doi: 10.1016/j.ejcts.2010.11.059. Epub 2011 Jan 15.
The introduction of modern staging systems such as computed tomography (CT) and positron emission tomography/CT (PET/CT) with fluorodeoxyglucose ([(18)F]FDG) has increased the detection of small peripheral lung cancers at an early stage. We analyzed the behavior of pathological T1 non-small-cell lung cancer (NSCLC) to identify criteria predictive of nodal involvement, and the role of cancer size in lymph node metastases.
We retrospectively analyzed 219 patients with pathological T1 NSCLC. All patients were staged by high-resolution CT and PET as stage I, and underwent anatomical resection and radical lymphadenectomy. Our data were collected based on pathological nodule size (0-10 mm; 11-20 mm; and 21-30 mm); morphological features of lung nodule and FDG uptake of the tumor measured by standardized uptake value (SUV).
A total of 190 patients (87%) were pN0, 14 (6%) pN1, and 15 (7%) pN2. No nodal involvement was observed in any of the 62 patients with nodule size less than 10 mm, in 20 out of 120 patients (17%) with nodule size 11-20 mm, and in nine out of 37 tumors (28%) 21-30 mm in size (p=0.0007). All 55 patients with nodule SUV<2.0 and all 26 non-solid lesions were pN0 (respectively, p=0.0001 and p=0.03). All nodal metastases occurred among the group of 132 patients with size larger than 10 mm and SUV higher than 2.0 with a 22% rate of nodal involvement of (29 patients) (p<0.0001).
The low probability of lymph node involvement in NSCLC <1 cm or showing glucose uptake <2 suggests lymphadenectomy could be avoided. A randomized trial should be performed to validate our data.
计算机断层扫描（CT）和正电子发射断层扫描/CT（PET/CT）与氟代脱氧葡萄糖（[(18)F]FDG）的引入提高了早期小周边型肺癌的检出率。我们分析了病理 T1 非小细胞肺癌（NSCLC）的行为，以确定预测淋巴结受累的标准，并确定肿瘤大小在淋巴结转移中的作用。
我们回顾性分析了 219 例病理 T1 NSCLC 患者。所有患者均通过高分辨率 CT 和 PET 分期为 I 期，并进行解剖性肺切除术和根治性淋巴结清扫术。我们的数据是基于病理结节大小（0-10mm；11-20mm；21-30mm）、肺结节的形态特征和肿瘤的标准化摄取值（SUV）摄取进行收集的。
共有 190 例（87%）患者为 pN0，14 例（6%）为 pN1，15 例（7%）为 pN2。在结节大小小于 10mm 的 62 例患者中，无一例发生淋巴结转移，结节大小为 11-20mm 的 120 例患者中有 20 例（17%），结节大小为 21-30mm 的 37 例患者中有 9 例（28%）发生淋巴结转移（p=0.0007）。所有结节 SUV<2.0 的 55 例患者和所有非实性病变的 26 例患者均为 pN0（分别为 p=0.0001 和 p=0.03）。所有淋巴结转移均发生在 132 例结节大小大于 10mm 且 SUV 高于 2.0 的患者中，淋巴结受累率为 22%（29 例）（p<0.0001）。
直径<1cm 或葡萄糖摄取<2 的 NSCLC 淋巴结受累的可能性较低，提示可以避免淋巴结清扫。应进行随机试验来验证我们的数据。
