老年非小细胞肺癌患者的纵隔淋巴结清扫术。

Mediastinal lymphadenectomy in elderly patients with non-small-cell lung cancer.

机构信息

Department of Thoracic Surgery, Haut Lévêque Hospital, University of Bordeaux, Bordeaux, France.

出版信息

Eur J Cardiothorac Surg. 2013 Jul;44(1):88-92. doi: 10.1093/ejcts/ezs586. Epub 2012 Nov 21.

DOI:10.1093/ejcts/ezs586

PMID:23171938

Abstract

OBJECTIVES

The progressive ageing of the population is accompanied by an increasing incidence of cancer. Our objective was to compare mediastinal lymphadenectomy performed in the surgical treatment of non-small-cell lung cancer (NSCLC) patients between ≥ 70 and <70.

METHODS

We performed a retrospective single-centre case-control study, including 80 patients ≥ 70 years of age, surgically treated for NSCLC between January 2008 and December 2010, matched 1:1 to 80 younger controls on gender, American Society of Anesthesia score, performance status and histological subtype of the tumour. The number and type of dissected hilar/intrapulmonary and mediastinal lymph node stations as well as the number of resected lymph nodes were compared between the two age groups.

RESULTS

The type of pulmonary resection was significantly different between the two groups (P = 0.03): pneumonectomy 6% (n = 5) for patients ≥ 70 vs 12% (n = 10) for patients <70, lobectomy 85 (n = 68) vs 65% (n = 52), bilobectomy 1 (n = 1) vs 2% (n = 2) and sub-lobar resection 7 (n = 6) vs 20% (n = 16). There was no significant difference in type of mediastinal lymphadenectomy (radical vs sampling; P = 0.6). Elderly patients presented a more advanced N status of lymph node invasion than younger controls (P = 0.02). The number and type of dissected lymph node stations and the number of lymph nodes were not significantly different between the two age groups (P = 0.66 and 0.25, respectively). The mean number of metastatic lymph nodes was higher in patients ≥ 70 (2.3 vs 1.3 in patients <70; P = 0.002). Lymph node ratio between metastatic and resected lymph nodes was higher in elderly patients (0.11 vs 0.07 in younger controls; P = 0.009).

CONCLUSIONS

Lymph node involvement in surgically treated NSCLC was more significant in elderly patients ≥ 70 than in younger patients presenting comparable clinical and histopathological characteristics, and undergoing a similar lymphadenectomy.

摘要

目的

人口老龄化伴随着癌症发病率的增加。我们的目的是比较 70 岁及以上和<70 岁非小细胞肺癌（NSCLC）患者手术治疗中纵隔淋巴结清扫的情况。

方法

我们进行了一项回顾性单中心病例对照研究，纳入了 2008 年 1 月至 2010 年 12 月期间接受手术治疗的 80 例 70 岁及以上的 NSCLC 患者，按照性别、美国麻醉医师协会评分、体力状况和肿瘤组织学亚型，与 80 例年龄较小的对照组 1:1 匹配。比较两组患者清扫的肺门/肺内和纵隔淋巴结站的数量和类型以及切除的淋巴结数量。

结果

两组患者的肺切除术类型有显著差异（P=0.03）：70 岁及以上患者行全肺切除术 6%（n=5），<70 岁患者行全肺切除术 12%（n=10），70 岁及以上患者行肺叶切除术 85 例（n=68），<70 岁患者行肺叶切除术 65%（n=52），70 岁及以上患者行双肺叶切除术 1 例（n=1），<70 岁患者行双肺叶切除术 2%（n=2），70 岁及以上患者行亚肺叶切除术 7 例（n=6），<70 岁患者行亚肺叶切除术 20%（n=16）。纵隔淋巴结清扫术的类型（根治性与取样性）无显著差异（P=0.6）。老年患者的淋巴结侵犯 N 分期比年轻对照组更晚（P=0.02）。两组患者的淋巴结清扫站数量和类型以及淋巴结数量无显著差异（P=0.66 和 0.25）。70 岁及以上患者的转移性淋巴结数量更高（2.3 个 vs 1.3 个，<70 岁患者；P=0.002）。老年患者的转移性淋巴结与切除淋巴结的淋巴结比值更高（0.11 比年轻对照组的 0.07；P=0.009）。