Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
J Thorac Oncol. 2011 Mar;6(3):525-30. doi: 10.1097/JTO.0b013e318206dbcc.
To address whether systematic lymph node dissection is always necessary in early lung cancer, we identified factors predicting nodal involvement in a screening series and applied them to nonscreening-detected cancers.
In the 97 patients with clinical T1-2N0M0 lung cancer (<3 cm), enrolled in the Continuous Observation of Smoking Subjects computed tomography (CT) screening study, who underwent curative resection with radical mediastinal lymph node dissection, we examined factors associated with hilar extrapulmonary and mediastinal nodal involvement. Nodule size plus positive/negative positron emission tomography (PET)-CT (usually as maximum standard uptake value [maxSUV]) were subsequently evaluated retrospectively for their ability to predict nodal involvement in 193 consecutive patients with nonscreening-detected clinical stage I lung cancer.
Among Continuous Observation of Smoking Subjects patients, 91 (94%) were pN0, and six (6.2%) were pN+. All patients with maxSUV <2.0 (p = 0.08) or pathological nodule ≤10 mm (p = 0.027) were pN0 (62 cases). Nodal metastases occurred in 6 cases among the 29 (17%) patients with lung nodule >10 mm and maxSUV ≥2.0 (p = 0.002 versus the other 62 cases). In the nonscreening series, 42 of 43 cases with negative PET-CT (usually maxSUV <2.0) or nodule ≤10 mm were pN0; 33 of 149 (22%) cases with positive PET-CT (usually maxSUV ≥ 2.0) and nodule >10 mm were pN+ (p = 0.001 versus the 43 cases).
This limited experience suggests that in early-stage clinically N0 lung cancers with maxSUV <2.0 or pathological nodule size ≤10 mm, systematic nodal dissection can be avoided as the risk of nodal involvement is very low.
为了确定系统淋巴结清扫术在早期肺癌中的必要性，我们在筛查系列中确定了预测淋巴结受累的因素，并将其应用于非筛查发现的癌症。
在连续观察吸烟人群 CT 筛查研究中，对 97 例临床 T1-2N0M0 肺癌（<3cm）患者进行根治性纵隔淋巴结清扫术，我们检查了与肺门外和纵隔淋巴结受累相关的因素。结节大小加正电子发射断层扫描（PET）-CT 阳性/阴性（通常为最大标准摄取值[maxSUV]）随后用于回顾性评估其在 193 例连续非筛查发现的 I 期肺癌患者中的预测淋巴结受累的能力。
在连续观察吸烟人群患者中，91 例（94%）为 pN0，6 例（6.2%）为 pN+。所有 maxSUV<2.0（p=0.08）或病理结节≤10mm（p=0.027）的患者均为 pN0（62 例）。结节>10mm 和 maxSUV≥2.0 的 29 例（17%）患者中，有 6 例发生淋巴结转移（p=0.002，与其他 62 例相比）。在非筛查系列中，43 例 PET-CT 阴性（通常 maxSUV<2.0）或结节≤10mm 的患者中，有 42 例为 pN0；149 例 PET-CT 阳性（通常 maxSUV≥2.0）和结节>10mm 的患者中，有 33 例为 pN+（p=0.001，与 43 例相比）。
这一有限的经验表明，在 maxSUV<2.0 或病理结节大小≤10mm 的早期临床 N0 肺癌中，系统淋巴结清扫术可以避免，因为淋巴结受累的风险非常低。
