Casali Christian, Stefani Alessandro, Morandi Uliano
Division of Thoracic Surgery, Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena, Italy.
Asian Cardiovasc Thorac Ann. 2011 Jun;19(3-4):217-24. doi: 10.1177/0218492311407904.
N1 non-small-cell lung cancer has heterogeneous prognosis in relation to node descriptors. There is no agreement on the ideal type of resection. A new classification of N1 descriptors was proposed in the 7(th) edition of the TNM staging system. A retrospective study was conducted on 384 patients with T1-T3N1 non-small-cell lung cancer who underwent complete pulmonary resection. The prognostic role of N1 descriptors according to the current and new staging systems and type of resection was investigated. The 5-year survival rate was 46%. Involvement of hilar node stations, multiple stations, and multiple nodes were poor prognostic factors (5-year survival, 33%, 21%, and 30%, respectively), as well as involvement of the hilar zone and multiple zones (5-year survival, 27% and 23%, respectively). Pneumonectomy showed significantly better survival rates compared to lobectomy or bilobectomy (5-year survival, 60% vs. 29%). Multivariate analysis showed that the number of N1 zones and type of resection were independent prognostic factors. Patients with hilar nodal, multiple-level, or multiple-zone involvement had poor prognosis. Standard lobectomy remains the procedure of choice, but in cases of fixed nodes in the hilar zone, sleeve resection or even pneumonectomy should be considered.
N1期非小细胞肺癌的预后与淋巴结描述符相关，存在异质性。对于理想的切除类型尚无共识。在TNM分期系统第7版中提出了一种新的N1描述符分类方法。对384例接受了全肺切除的T1-T3N1期非小细胞肺癌患者进行了一项回顾性研究。研究了根据当前和新分期系统的N1描述符以及切除类型的预后作用。5年生存率为46%。肺门淋巴结站受累、多个站受累以及多个淋巴结受累均为不良预后因素（5年生存率分别为33%、21%和30%），肺门区和多个区受累也是如此（5年生存率分别为27%和23%）。与肺叶切除术或双叶切除术相比，全肺切除术的生存率显著更高（5年生存率分别为60%和29%）。多变量分析表明，N1区数量和切除类型是独立的预后因素。肺门淋巴结受累、多水平受累或多区受累的患者预后较差。标准肺叶切除术仍然是首选术式，但对于肺门区淋巴结固定的病例，应考虑袖状切除术甚至全肺切除术。
