The Multidisciplinary Thoracic Oncology Program, Boston Baskin Cancer Foundation, Baptist Cancer Center, Memphis, TN 38120 , USA.
J Thorac Oncol. 2012 Aug;7(8):1276-82. doi: 10.1097/JTO.0b013e318257fbe5.
Pathologic examination of mediastinal lymph nodes (MLNs) after resection of non-small-cell lung cancer is critical in the determination of prognosis and postoperative management. Although systematic nodal dissection is recommended, the quality of pathologic lymph-node staging often falls short of recommendations in practice. We tested the feasibility of improving pathologic lymph-node staging of resectable non-small-cell lung cancer by using a prelabeled specimen-collection kit.
Case-control study with comparison of 51 resections, using a special lymph-node collection kit, with 51 controls matched for surgeon, extent of resection, pathologist, and T category. Appropriate statistical methods were used for all comparisons.
The median number of MLNs examined increased from one in the control group, to six in the case group (p < 0.001). The percentage of resections attaining the National Comprehensive Cancer Network-recommended quality of MLN examination, and the proportion that would have been eligible for recent landmark postresection adjuvant therapy trials increased significantly (p < 0.001). The duration of surgery and postoperative complication rates were similar between cases and controls. Eighteen percent of kit cases had positive MLN, compared with 8% of controls.
The use of a specialized specimen-collection kit for MLN examination was feasible, markedly improved MLN staging, and showed a trend toward increased detection of patients with MLN metastasis, with only a modest increase in duration of surgery, and no increase in perioperative morbidity, mortality, or hospital length of stay.
非小细胞肺癌切除术后纵隔淋巴结（MLN）的病理检查对预后和术后管理的判断至关重要。虽然推荐进行系统淋巴结清扫，但病理淋巴结分期的质量在实践中往往达不到建议的标准。我们通过使用预标记的标本采集试剂盒来测试提高可切除性非小细胞肺癌的病理淋巴结分期的可行性。
采用病例对照研究，比较了 51 例使用特殊淋巴结收集试剂盒的切除术，以及 51 例与手术医生、切除范围、病理学家和 T 分期相匹配的对照组。对所有比较均使用了适当的统计方法。
对照组检查的 MLN 中位数为 1 个，而病例组为 6 个（p<0.001）。达到国家综合癌症网络推荐的 MLN 检查质量的切除率，以及符合最近标志性术后辅助治疗试验资格的比例显著增加（p<0.001）。手术时间和术后并发症发生率在病例组和对照组之间相似。试剂盒组有 18%的病例有阳性 MLN，而对照组为 8%。
使用专门的 MLN 检查标本采集试剂盒是可行的，可显著改善 MLN 分期，并显示出增加检测 MLN 转移患者的趋势，而手术时间仅略有增加，围手术期发病率、死亡率或住院时间无增加。
