Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
J Thorac Oncol. 2012 Aug;7(8):1246-51. doi: 10.1097/JTO.0b013e31825871de.
Even for patients with clinical N0 non-small-cell lung cancer (NSCLC), several invasive tests are available to pathologically confirm the presumptive mediastinal stage by radiologic modalities. The aim of this study was to determine a high-risk population for mediastinal nodal metastasis in patients with clinical stage IA NSCLC, which would be suitable for mediastinal staging by invasive modalities, such as mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.
We retrospectively reviewed peripheral clinical stage IA NSCLC patients who had undergone surgical resection with systematic mediastinal lymphadenectomy from 1998 to 2011. To identify predictors for mediastinal nodal metastasis, univariate and multivariate logistic regression analyses were performed. For the significant factors, optimal cutoff points were determined with a receiver operating characteristic analysis.
Among the 894 patients eligible for this study, the overall prevalence of mediastinal nodal metastasis was 7.5%. The following four predictors for mediastinal nodal metastasis were identified: age, preoperative serum carcinoembryonic antigen level, tumor size on preoperative radiologic findings, and consolidation/tumor ratio on high-resolution computed tomography. Of the patients with all four predictors identified by the multivariate analyses and receiver operating characteristic analyses (age ≤ 67 years, carcinoembryonic antigen ≥ 3.5 ng/ml, tumor size ≥ 2.0 cm, and consolidation/tumor ratio ≥ 89%), the prevalence of mediastinal nodal metastasis was 33.8%.
Among the clinical stage IA NSCLC patients in whom all four predictors were identified, one third of the patients showed mediastinal nodal metastasis, and thus, those patients should be a target for mediastinal node assessment by invasive modalities, such as mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.
即使对于临床 N0 期非小细胞肺癌（NSCLC）患者，也有几种有创检查可通过影像学手段对疑似纵隔期进行病理确认。本研究旨在确定临床 IA 期 NSCLC 患者中纵隔淋巴结转移的高危人群，这些患者适合通过纵隔镜或支气管内超声引导经支气管针吸活检等有创方式进行纵隔分期。
我们回顾性分析了 1998 年至 2011 年间接受手术切除和系统性纵隔淋巴结清扫术的外周临床 IA 期 NSCLC 患者。为了确定纵隔淋巴结转移的预测因素，我们进行了单因素和多因素逻辑回归分析。对于有意义的因素，我们使用受试者工作特征分析确定最佳截断点。
在符合本研究条件的 894 例患者中，纵隔淋巴结转移的总体发生率为 7.5%。确定了四个与纵隔淋巴结转移相关的预测因素：年龄、术前血清癌胚抗原水平、术前影像学检查肿瘤大小和高分辨率计算机断层扫描上的实变/肿瘤比值。通过多因素分析和受试者工作特征分析确定的所有四个预测因素（年龄≤67 岁、癌胚抗原≥3.5ng/ml、肿瘤大小≥2.0cm、实变/肿瘤比值≥89%）的患者中，纵隔淋巴结转移的发生率为 33.8%。
在所有四个预测因素均被确定的临床 IA 期 NSCLC 患者中，三分之一的患者存在纵隔淋巴结转移，因此这些患者应成为纵隔镜或支气管内超声引导经支气管针吸活检等有创方式评估纵隔淋巴结的目标人群。
