Key Laboratory of Cancer Prevention of Tianjin, Cancer Institute and Hospital of Tianjin Medical University, Huan Hu Xi Road, He Xi District, Tianjin, People's Republic of China.
Clin Transl Oncol. 2014 Jan;16(1):77-84. doi: 10.1007/s12094-013-1043-z. Epub 2013 Apr 25.
Curative surgery remains the priority for treatment of stage IA non-small cell lung cancer (NSCLC). The purpose of this study is to investigate if the extent of lymph node (LN) dissections affect the prognosis of resected stage IA NSCLC.
A total of 110 stage IA NSCLC patients who underwent curative resections were reviewed. The patients were classified according to the number of lymph nodes dissected (N) and levels sampled (NL, N2). The tumor residuals of 2,251 LNs were detected by immunohistochemistry (IHC). The Flow Cytometry (FACS) of the peripheral blood (PB) and LNs was used to evaluate patients' immunity. The relationship between the studied factors and the correlation with disease-free survival (DFS) was analyzed.
Disease free survival was improved as the extent of dissections increased in terms of N, NL and N2 (p = 0.005, <0.001, <0.001). Multivariate tests suggested N, N2 and NL (p = 0.001, 0.001, <0.001) were independent risk factors. However, the detection of tumor residuals also increased with the extent of dissection (p = 0.023, <0.001) while the presence of micrometastasis (MM) correlated with poor DFS (p = 0.028). Increased N represented weakened innate immunity (p = 0.048). Multivariate tests did not indicate a correlation between immunity and patients' DFS (p = 0.074).
The more extensive lymph node dissections achieved better disease control for stage IA NSCLC. Greater retrieval of LNs did not imply enhanced innate immunity; nor did their immunity level affect survival.
对于 IA 期非小细胞肺癌（NSCLC）的治疗，根治性手术仍是首选。本研究旨在探讨淋巴结清扫范围是否影响可切除 IA 期 NSCLC 的预后。
回顾性分析 110 例接受根治性切除术的 IA 期 NSCLC 患者。根据清扫的淋巴结数量（N）和取样的淋巴结水平（NL、N2）对患者进行分类。采用免疫组化（IHC）检测 2251 个淋巴结的肿瘤残留情况。采用外周血（PB）和淋巴结的流式细胞术（FACS）评估患者的免疫功能。分析研究因素与无病生存（DFS）的相关性。
随着 N、NL 和 N2 清扫范围的增加，DFS 得到改善（p=0.005、<0.001、<0.001）。多变量检验提示 N、N2 和 NL（p=0.001、0.001、<0.001）是独立的危险因素。然而，随着清扫范围的增加，肿瘤残留的检出率也随之增加（p=0.023、<0.001），而微转移（MM）与DFS 不良相关（p=0.028）。N 的增加代表固有免疫减弱（p=0.048）。多变量检验未表明免疫与患者 DFS 之间存在相关性（p=0.074）。
IA 期 NSCLC 淋巴结清扫范围越广，疾病控制效果越好。增加淋巴结的检出并不能增强固有免疫，也不能影响患者的生存。
