Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Thorac Surg. 2013 Sep;96(3):969-75; discussion 975-6. doi: 10.1016/j.athoracsur.2013.04.070. Epub 2013 Aug 2.
This study was undertaken to compare clinicopathologic features and survival between patients with unexpected N1 (clinical N0-pathologic N1) and expected N1 disease (clinical N1-pathologic N1) after operation for non-small cell lung cancer.
From 2003 to 2009, 305 patients who were found to have pathologic N1 disease after complete resection were retrospectively analyzed. Among these, 177 patients had negative findings for both computed tomography (CT) and positron emission tomography (PET)/CT (group cN0). Sixty-eight patients had negative CT and positive PET/CT or positive CT and negative PET/CT findings (group cN0-1). Sixty patients had positive findings for both CT and PET/CT (group cN1).
Patients in the cN1 group had larger tumors (p<0.001), greater pathologic T stage (p=0.018), and greater percentage of squamous cell carcinoma (p<0.001) than did those in the other groups. Patients in the cN1 group had a greater number of positive N1 lymph nodes (p=0.004) and more frequent extracapsular nodal invasion (p<0.001). The 5-year overall survival was 66%, 63%, and 58% in groups cN0, cN0-1, and cN1, respectively (cN0 vs cN0-1, p=0.958; cN0 vs cN1, p=0.038). The 5-year disease-free survival was 54%, 52%, and 39% in groups cN0, cN0-1, and cN1, respectively (cN0 vs cN0-1, p=0.862; cN0 vs cN1, p=0.01).
Patients with unexpected N1 disease showed better survival than did those with expected N1 disease, which seemed to be related to the pathologically minimal extent of the primary tumor and nodal involvement.
本研究旨在比较非小细胞肺癌术后意外 N1（临床 N0-病理 N1）和预期 N1 疾病（临床 N1-病理 N1）患者的临床病理特征和生存情况。
2003 年至 2009 年，回顾性分析了 305 例完全切除术后病理发现 N1 疾病的患者。其中，177 例 CT 和正电子发射断层扫描（PET）/CT 均为阴性（cN0 组）。68 例 CT 阴性，PET/CT 阳性或 CT 阳性，PET/CT 阴性（cN0-1 组）。60 例 CT 和 PET/CT 均为阳性（cN1 组）。
cN1 组患者的肿瘤较大（p<0.001），病理 T 分期较大（p=0.018），且鳞状细胞癌比例较高（p<0.001）。cN1 组患者阳性 N1 淋巴结数量较多（p=0.004），包膜外淋巴结侵犯更频繁（p<0.001）。cN0、cN0-1 和 cN1 组患者的 5 年总生存率分别为 66%、63%和 58%（cN0 与 cN0-1 比较，p=0.958；cN0 与 cN1 比较，p=0.038）。cN0、cN0-1 和 cN1 组患者的 5 年无病生存率分别为 54%、52%和 39%（cN0 与 cN0-1 比较，p=0.862；cN0 与 cN1 比较，p=0.01）。
意外 N1 疾病患者的生存情况优于预期 N1 疾病患者，这似乎与肿瘤原发灶和淋巴结受累的病理最小程度有关。
