回顾性分析病理 N2 期非小细胞肺癌中肿瘤部位与淋巴结转移模式的关系。
Retrospective analysis of nodal spread patterns according to tumor location in pathological N2 non-small cell lung cancer.
机构信息
First Department of Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
出版信息
World J Surg. 2012 Dec;36(12):2865-71. doi: 10.1007/s00268-012-1743-5.
BACKGROUND
The purpose of the present study was to determine the nodal spread patterns of pN2 non-small cell lung cancer (NSCLC) according to tumor location, and to attempt to evaluate the possible indications of selective lymph node dissection (SLND).
METHODS
We retrospectively analyzed nodal spread patterns in 207 patients with NSCLC of less than 5 cm with N2 involvement.
RESULTS
The tumor location was right upper lobe (RUL) in 79, middle lobe in 12, right lower lobe (RLL) in 40, left upper division (LUD) in 41, lingular division in 11, and left lower lobe (LLL) in 24. Both RUL and LUD tumors showed a higher incidence of upper mediastinal (UM) involvement (96 and 100%, respectively) and a lower incidence of subcarinal involvement (15 and 10%, respectively) than lower lobe tumors (UM; RLL 60%, LLL 42%; subcarinal: RLL 60%, LLL 46%, respectively). Among the patients with 24 right UM-positive RLL and 10 left UM-positive LLL tumors, 2 showed negative hilar, subcarinal, and lower mediastinal involvement, and cT1, suggesting that UM dissection may be unnecessary in lower lobe tumors with no metastasis to hilar, subcarinal, and lower mediastinal nodes on frozen sections according to the preoperative T status. Among the patients with 12 subcarinal-positive RUL and 4 subcarinal-positive LUD tumors, one showed negative hilar or UM involvement, suggesting that subcarinal dissection may be unnecessary in RUL or LUD tumors with no metastasis to hilar and UM nodes on frozen sections.
CONCLUSIONS
The present study appears to provide one of the supportive results regarding the treatment strategies for tumor location-specific SLND.
背景
本研究旨在根据肿瘤位置确定 pN2 非小细胞肺癌（NSCLC）的淋巴结转移模式，并尝试评估选择性淋巴结清扫术（SLND）的可能适应证。
方法
我们回顾性分析了 207 例小于 5cm、伴有 N2 转移的 NSCLC 患者的淋巴结转移模式。
结果
肿瘤位置为右上叶（RUL）79 例，中叶 12 例，右下叶（RLL）40 例，左上叶前段（LUD）41 例，舌段 11 例，左下叶（LLL）24 例。RUL 和 LUD 肿瘤均以上纵隔（UM）受累发生率较高（分别为 96%和 100%），而隆突下受累发生率较低（分别为 15%和 10%），低于下叶肿瘤（UM；RLL 为 60%，LLL 为 42%；隆突下：RLL 为 60%，LLL 为 46%）。在 24 例右侧 UM 阳性的 RLL 和 10 例左侧 UM 阳性的 LLL 肿瘤中，有 2 例显示无肺门、隆突下和下纵隔淋巴结转移，且为 cT1，提示对于术前 T 分期提示无肺门、隆突下和下纵隔淋巴结转移的下叶肿瘤，UM 清扫可能不必要。在 12 例隆突下阳性的 RUL 和 4 例隆突下阳性的 LUD 肿瘤中，有 1 例显示无肺门或 UM 受累，提示对于术前 T 分期提示无肺门和 UM 淋巴结转移的 RUL 或 LUD 肿瘤，隆突下清扫可能不必要。
结论
本研究似乎为肿瘤位置特异性 SLND 治疗策略提供了支持性结果之一。
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