Division of Cardiothoracic Surgery, Section of Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Ann Thorac Surg. 2012 Sep;94(3):902-6. doi: 10.1016/j.athoracsur.2012.05.034. Epub 2012 Jul 7.
The American College of Surgery Oncology Group Z0030 study was a prospective randomized study that showed that mediastinal lymph node sampling (MLNS) offered similar results to mediastinal lymph node dissection (MLND) in patients with non-small cell lung cancer (NSCLC). However, that study only randomized patients after thorough samplings that were negative on frozen section in several N2 and N1 nodal stations. The purpose of this study was to evaluate the effect of MLND to the more common practice of ruling out N2 disease preoperatively and then resection without sending lymph nodes for frozen section.
This is a retrospective study of patients clinically staged as N0 with NSCLC. The incidence of pathologic N2 disease reported by the Society of Thoracic Surgeons (STS) database was considered to represent MLNS and it was compared with our patients who underwent complete MLND.
Between January 2002 and December 2009, 1,358 patients clinically staged as N0 underwent lobectomy or segmentectomy and MLND (not MLNS). Our incidence of pathologic N2 disease in 1,107 patients who underwent lobectomy was 10.6% compared with 9.4% in the 24,896 STS lobectomy patients (p=0.196). Our incidence of pathologic N2 disease in 251 patients who underwent segmentectomy was 13.0% compared with 5.3% in the 2,150 STS segmentectomy patients (p<0.001).
When complete MLND is performed in patients during pulmonary resection who are clinically node negative (have benign N2 nodes after selective endobronchial or esophageal ultrasound or mediastinoscopy) without using intraoperative frozen section of N2 or N1, more patients are pathologically staged with N2 disease; thus, more are considered for adjuvant chemotherapy. The impact on survival in these patients is unproven.
美国外科医师学院肿瘤学组 Z0030 研究是一项前瞻性随机研究，表明纵隔淋巴结采样（MLNS）在非小细胞肺癌（NSCLC）患者中与纵隔淋巴结清扫（MLND）提供相似的结果。然而，该研究仅在对几个 N2 和 N1 淋巴结站的冷冻切片阴性的患者进行彻底采样后对患者进行随机分组。本研究旨在评估 MLND 对更为常见的术前排除 N2 疾病并随后不送淋巴结进行冷冻切片的切除术的影响。
这是一项对临床分期为 N0 的 NSCLC 患者的回顾性研究。胸外科医师学会（STS）数据库报告的病理性 N2 疾病的发生率被认为代表 MLNS，并与我们进行完整 MLND 的患者进行比较。
2002 年 1 月至 2009 年 12 月，1358 例临床分期为 N0 的患者接受了肺叶切除术或肺段切除术和 MLND（非 MLNS）。我们在 1107 例接受肺叶切除术的患者中病理性 N2 疾病的发生率为 10.6%，而 STS 肺叶切除术患者的 24896 例中为 9.4%（p=0.196）。我们在 251 例接受肺段切除术的患者中病理性 N2 疾病的发生率为 13.0%，而 STS 肺段切除术患者的 2150 例中为 5.3%（p<0.001）。
在对临床淋巴结阴性（选择性支气管内或食管超声或纵隔镜检查后有良性 N2 淋巴结）的肺切除术中患者进行完整的 MLND 时，如果不使用 N2 或 N1 的术中冷冻切片，更多的患者会进行病理性 N2 分期；因此，更多的患者被认为需要辅助化疗。这些患者的生存影响尚未得到证实。
