胸腺癌行淋巴结清扫的重要性。

Importance of lymph node dissection in thymic carcinoma.

机构信息

Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Ann Thorac Surg. 2013 Sep;96(3):1025-32; discussion 1032. doi: 10.1016/j.athoracsur.2013.04.057. Epub 2013 Jun 24.

DOI:10.1016/j.athoracsur.2013.04.057

PMID:23806232

Abstract

BACKGROUND

Lymph node dissection plays important role in oncologic surgery. We investigated outcomes of lymph node dissection in thymic carcinoma.

METHODS

We retrospectively reviewed 37 patients, who underwent complete resection for thymic carcinoma. Patients were divided into four groups: no node dissection (Nx), 8; pathologic N0 by limited dissection (N0a), 13; pathologic N0 by extensive dissection (N0b), 10; and node metastasis (N1), 6. Outcomes of lymph node dissection were investigated. Disease-free survival (DFS) and freedom from recurrence of the four groups were compared.

RESULTS

A total of 349 lymph nodes were dissected in 29 patients. Metastasis was confirmed in 19 nodes in 6 patients, with tumor invading adjacent organs. Anterior mediastinal lymph node metastasis was confirmed in 4 patients. Intrathoracic lymph node metastasis was confirmed in 3 patients at the right paratracheal lymph nodes. Recurrences were diagnosed in 11 patients (Nx, 2; N0a, 4; N0b, 1; N1, 4). The 5-year overall survival rate was 65.5%, DFS was 60.9%, and freedom from recurrence was 68.2%. DFS rates of the N0b subgroup were significantly better than in the N1 subgroup (90% vs 33.3%). DFS rates of the Nx and N0a subgroups were similar (75% vs 48.7%, p=0.98), and the prognoses of both groups were intermediate between the N0b and N1 groups. Analyses of freedom from recurrence proved identical results.

CONCLUSIONS

Extensive lymph node dissection, meaning dissection of more than 10 lymph nodes, is required to predict prognosis accurately. Anterior mediastinal and right paratracheal lymph nodes should be dissected in thymic carcinoma.

摘要

背景

淋巴结清扫在肿瘤外科中起着重要作用。我们研究了胸腺癌淋巴结清扫的结果。

方法

我们回顾性分析了 37 例接受胸腺癌完全切除术的患者。患者分为 4 组：无淋巴结清扫（Nx）8 例，局限性清扫病理 N0（N0a）13 例，广泛清扫病理 N0（N0b）10 例，淋巴结转移（N1）6 例。研究了淋巴结清扫的结果。比较了 4 组的无病生存率（DFS）和无复发率。

结果

29 例患者共清扫 349 枚淋巴结。6 例患者的 19 枚淋巴结有转移，肿瘤侵犯相邻器官。4 例患者前纵隔淋巴结转移，3 例患者右侧气管旁淋巴结纵隔内淋巴结转移。11 例患者复发（Nx2 例，N0a4 例，N0b1 例，N14 例）。5 年总生存率为 65.5%，DFS 为 60.9%，无复发率为 68.2%。N0b 亚组的 DFS 率明显优于 N1 亚组（90% vs. 33.3%）。Nx 和 N0a 亚组的 DFS 率相似（75% vs. 48.7%，p=0.98），且两组的预后均介于 N0b 和 N1 组之间。无复发率分析结果相同。