Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
Division of Pulmonary and Critical Care Medicine, Mount Sinai Medical Center, New York, NY.
Chest. 2013 Nov;144(5):1615-1621. doi: 10.1378/chest.12-3069.
Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early-stage non-small cell lung cancer (NSCLC). However, the benefits of complete lymphadenectomy are unproven. There is evidence suggesting a predictable pattern of mediastinal nodal drainage. This study analyzed the frequency and pattern of mediastinal nodal disease and its impact on outcome in patients with early-stage NSCLC.
Patients with clinical N0/N1 NSCLC staged with CT scans and PET scans were identified. Disease involvement of resected nodal stations was recorded. Patterns of recurrence in patients who underwent lobectomy with complete mediastinal systematic lymph node sampling (SLNS) were compared with those who underwent lobe-specific mediastinal SLNS.
From July 2004 to April 2011, 370 patients were identified. Complete SLNS was performed in 282 patients. Fifteen patients (5.3%) in the group with complete SLNS were found to have N2 disease after pathologic evaluation. Patients with left-sided tumors were more likely to have pathologic N2 disease than were patients with right-sided tumors (P = .03). Only one patient (0.36%) had positive N2 disease in the distal mediastinum while skipping lobe-specific mediastinal nodes. In addition, patients with complete SLNS had a rate of recurrence similar to that of the group that had lobe-specific mediastinal evaluation (20.6% vs 18.2%, P = .68).
Mediastinal N2 metastases follow predictable lobe-specific patterns in patients with negative preoperative CT scans and PET scans. Lobe-specific N2 nodal evaluation results in a recurrence rate similar to that of complete mediastinal evaluation. Lobe-specific mediastinal nodal evaluation appears acceptable in patients with early-stage NSCLC.
肺叶切除术加完全纵隔淋巴结清扫术被认为是早期非小细胞肺癌（NSCLC）患者的标准治疗方法。然而，完全淋巴结清扫术的益处尚未得到证实。有证据表明纵隔淋巴结引流存在可预测的模式。本研究分析了早期 NSCLC 患者纵隔淋巴结疾病的频率和模式及其对预后的影响。
确定了经 CT 扫描和 PET 扫描分期为临床 N0/N1 NSCLC 的患者。记录了切除淋巴结站的疾病累及情况。比较了行肺叶切除术加完全纵隔系统性淋巴结采样（SLNS）与行肺叶特异性纵隔 SLNS 的患者的复发模式。
从 2004 年 7 月至 2011 年 4 月，共确定了 370 例患者。282 例患者行完全 SLNS。完全 SLNS 组中有 15 例（5.3%）患者在病理评估后发现 N2 疾病。左侧肿瘤患者发生病理 N2 疾病的可能性高于右侧肿瘤患者（P=0.03）。只有 1 例（0.36%）患者在跳过肺叶特异性纵隔淋巴结的情况下出现远端纵隔阳性 N2 疾病。此外，完全 SLNS 组的复发率与仅行肺叶特异性纵隔评估组相似（20.6%比 18.2%，P=0.68）。
在术前 CT 扫描和 PET 扫描阴性的患者中，纵隔 N2 转移遵循可预测的肺叶特异性模式。肺叶特异性 N2 淋巴结评估的复发率与完全纵隔评估相似。肺叶特异性纵隔淋巴结评估在早期 NSCLC 患者中似乎是可以接受的。
