对比肺癌分期的系统性纵隔淋巴结清扫与系统性采样，以及手术的完整性。

Comparison of systematic mediastinal lymph node dissection versus systematic sampling for lung cancer staging and completeness of surgery.

机构信息

Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China.

出版信息

J Surg Res. 2011 Dec;171(2):e169-73. doi: 10.1016/j.jss.2011.04.045. Epub 2011 May 20.

DOI:10.1016/j.jss.2011.04.045

PMID:21962744

Abstract

BACKGROUND

This self-controlled prospective study was designed to investigate the efficacy of systematic sampling (SS), compared with systematic mediastinal lymph node dissection (SMLD), for pathologic staging and completeness of surgery.

METHODS

Over a period of 11 mo, 110 patients with lung cancer were enlisted and treated by pulmonary resection. Surgeons systematically sampled mediastinal lymph nodes prior to pulmonary resection, and after pulmonary resection SMLD was performed to each patient using Mountain's procedure [1].

RESULTS

After SMLD, pN status was classified as N0 in 57 cases, N1 in 27, and N2 in 26. SS detected 38.3% of pooled nodes and 37.6% of pooled positive nodes collected from SMLD. Pathologic diagnosis after SS was understaged in nine cases (8.2%) compared with staging after SMLD. However, surgery was incomplete in 24 cases (21.8%) if SMLD was not performed after sampling. Negative predictive value for SS was 86.8% on the right side, and 95.0% on the left. Three categories were generated according to pN status: negative nodes in SS and additional negative nodes from SMLD [S(-)D(-)], negative nodes in SS but additional positive nodes from SMLD [S(-)D(+)], and positive nodes in SS [S(+)D(+)]. cN2 (P=0.000) and CEA level (P=0.001) were correlated with pN status. There was significant overall survival difference between non-N2 group and N2 group (P=0.002).

CONCLUSIONS

SMLD may harvest about three times of mediastinal lymph nodes compared with SS. SS is more likely to affect the completeness of surgery instead of underrating pathologic stage.

摘要

背景

本研究为自身对照前瞻性研究，旨在探讨系统性采样（SS）与系统性纵隔淋巴结清扫（SMLD）在病理分期和手术完整性方面的疗效。

方法

在 11 个月的时间里，共纳入 110 例肺癌患者，接受肺切除术治疗。在肺切除术前，外科医生对纵隔淋巴结进行系统性采样，然后对每位患者采用 Mountain 方法[1]进行 SMLD。

结果

在 SMLD 后，pN 状态分类为 N0 57 例，N1 27 例，N2 26 例。SS 检测到 SMLD 收集的总淋巴结中 38.3%和总阳性淋巴结中 37.6%的淋巴结。与 SMLD 后分期相比，SS 后病理诊断分期低估了 9 例（8.2%）。然而，如果不进行采样后的 SMLD，24 例（21.8%）手术不完整。SS 的阴性预测值在右侧为 86.8%，在左侧为 95.0%。根据 pN 状态生成了 3 个类别：SS 中的阴性淋巴结和 SMLD 中额外的阴性淋巴结[S(-)D(-)]、SS 中的阴性淋巴结但 SMLD 中有额外的阳性淋巴结[S(-)D(+)]以及 SS 中的阳性淋巴结[S(+)D(+)]。cN2（P=0.000）和 CEA 水平（P=0.001）与 pN 状态相关。非 N2 组与 N2 组之间的总体生存率存在显著差异（P=0.002）。