Jeon Hyun Woo, Moon Mi Hyung, Kim Kyung Soo, Kim Young Du, Wang Young Pil, Park Hyung Joo, Park Jae Kil
Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2014 Oct;62(7):599-604. doi: 10.1055/s-0033-1360478. Epub 2014 Jan 13.
Lobectomy and mediastinal lymph node dissection comprise the standard surgical treatment for non-small cell lung cancer (NSCLC). Although complete mediastinal lymph node dissection has been recommended as part of the procedure for achieving complete resection, the benefits for early lung cancer are unclear. The purpose of this study was to determine the effects of different degrees of mediastinal lymph node dissection on the clinical outcomes of patients with clinical stage I NSCLC.
The records of patients with clinical stage I NSCLC treated between January 2000 and September 2010 were reviewed retrospectively. This study consisted of 211 patients who underwent lobectomy plus mediastinal lymph node dissection and sampling. Patients were divided into a group who underwent lymphadenectomy (LA) including complete mediastinal node dissection or lobe-specific lymph node dissection and a group who underwent selective lymph node sampling (LS). Clinical outcomes, including survival, and prognostic factors were determined.
The mean (±) number of extracted lymph nodes for the LS and LA patients was 7.50 ± 5.44 and 14.09 ± 7.57, respectively (p < 0.001). Male and diabetes mellitus patients were more associated with LS. Survival of the LA patients was significantly longer (p = 0.029). By multivariate analysis, extent of mediastinal nodal sampling (p = 0.029) and positive for mediastinal nodal (N2-positive) disease (p = 0.046) were significant predictors for survival.
The extent of dissection of mediastinal lymph nodes affected the clinical outcomes of our study patients with clinical stage I NSCLC. At least evaluation of lobe-specific lymph node dissection is required.
肺叶切除术和纵隔淋巴结清扫术是非小细胞肺癌（NSCLC）的标准外科治疗方法。尽管完全纵隔淋巴结清扫术被推荐作为实现完全切除手术的一部分，但对早期肺癌的益处尚不清楚。本研究的目的是确定不同程度的纵隔淋巴结清扫术对临床I期NSCLC患者临床结局的影响。
回顾性分析2000年1月至2010年9月期间接受治疗的临床I期NSCLC患者的记录。本研究包括211例行肺叶切除术加纵隔淋巴结清扫及采样的患者。患者分为两组，一组接受包括完全纵隔淋巴结清扫或肺叶特异性淋巴结清扫的淋巴结切除术（LA），另一组接受选择性淋巴结采样（LS）。确定包括生存率在内的临床结局和预后因素。
LS组和LA组患者平均提取的淋巴结数分别为7.50±5.44个和14.09±7.57个（p<0.001）。男性和糖尿病患者与LS的相关性更高。LA组患者的生存期明显更长（p=0.029）。多因素分析显示，纵隔淋巴结采样范围（p=0.029）和纵隔淋巴结（N2阳性）疾病阳性（p=0.046）是生存的重要预测因素。
纵隔淋巴结清扫范围影响了本研究中临床I期NSCLC患者的临床结局。至少需要评估肺叶特异性淋巴结清扫情况。
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