系统性纵隔淋巴结清扫术在支气管源性癌精确分期中的重要性。

Importance of systemic mediastinal lymphadenectomy in exact staging of bronchogenic carcinoma.

作者信息

Hytych V, Taskova A, Horazdovsky P, Konopa Z, Demes R, Cermak J, Vrabcova A, Hoferka P, Pohnan R

出版信息

Bratisl Lek Listy. 2013;114(10):569-72. doi: 10.4149/bll_2013_121.

DOI:10.4149/bll_2013_121

PMID:24156680

Abstract

BACKGROUND

Constituent part of radical lung resection for lung cancer is a dissection of mediastinal lymph nodes. Lymphadenectomy is a standard procedure in an assessment of clinical stage of the disease. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of mediastinal lymphadenectomy for exact staging and survival.

METHODS

Study of 31patients with lung resection and systematic mediastinal lymphadenectomy operated from August 2004 to January 2007, with pre-operative stage Ia to IIb (TNM classification) - according to CT without mediastinal lymph nodes invasion and with positive histological finding after systematic mediastinal lymphadenectomy.

RESULTS

Tumors in right upper lobe metastasized in 45.5 % into group 1 nodes (stages N1-N4) and group 3 nodes (stages N7) and in 9 % into group 4 nodes (stages N8-N9). Tumors of the right middle lobe metastasized in 100 % into group 3 nodes (stage N7).Tumors of the right lower lobe metastasized in 87.5 % into group 3 nodes (N7) and in 12.5 % into group 4 nodes (stages N8-N9). Tumors of the left upper lobe metastasized in 9.0 % in group 1 nodes (stages N1-N4), in 82 % into group 2 nodes (stages N5-N6) and in 9.0 % were found skip metastases into group 4 nodes (stages N8-N9). Tumors of the left lower lobe metastasized in 26.7 % in group 4 nodes, 46.6 % into group 3 nodes, in 20,0 % into group 2 nodes and in 6,7 % into group 1 nodes.

CONCLUSION

Systematic mediastinal lymphadenectomy is crucial for determining the stage of the disease according to the TNM classification. Systematic lymphadenectomy is essential for the diagnosis of stage IIIa disease and setting of additional therapy that prolongs survival (Ref. 17).

摘要

背景

肺癌根治性肺切除术的组成部分是纵隔淋巴结清扫。淋巴结切除术是评估疾病临床分期的标准程序。本研究的目的是描绘支气管源性非小细胞肺癌向同侧纵隔淋巴结转移的情况，并评估纵隔淋巴结清扫对于准确分期和生存的重要性。

方法

研究对象为2004年8月至2007年1月接受肺切除术及系统性纵隔淋巴结清扫术的31例患者，术前分期为Ia至IIb期（TNM分类）——根据CT检查无纵隔淋巴结侵犯，系统性纵隔淋巴结清扫术后组织学检查结果为阳性。

结果

右上叶肿瘤转移至1组淋巴结（N1 - N4期）和3组淋巴结（N7期）的比例为45.5%，转移至4组淋巴结（N8 - N9期）的比例为9%。右中叶肿瘤转移至3组淋巴结（N7期）的比例为100%。右下叶肿瘤转移至3组淋巴结（N7）的比例为87.5%，转移至4组淋巴结（N8 - N9期）的比例为12.5%。左上叶肿瘤转移至1组淋巴结（N1 - N4期）的比例为9.0%，转移至2组淋巴结（N5 - N6期）的比例为82%，跳跃转移至4组淋巴结（N8 - N9期）的比例为9.0%。左下叶肿瘤转移至4组淋巴结的比例为26.7%，转移至3组淋巴结的比例为46.6%，转移至2组淋巴结的比例为20.0%，转移至1组淋巴结比例为6.7%。