完全切除的左上叶肿瘤中主动脉肺区（第5和6组）淋巴结转移的预后意义

The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors.

作者信息

Citak Necati, Sayar Adnan, Metin Muzaffer, Büyükkale Songül, Kök Abdulaziz, Solak Okan, Yurt Sibel, Gürses Atilla

机构信息

Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.

出版信息

Thorac Cardiovasc Surg. 2015 Oct;63(7):568-76. doi: 10.1055/s-0035-1546463. Epub 2015 Apr 20.

DOI:10.1055/s-0035-1546463

PMID:25893919

Abstract

INTRODUCTION

We investigated the prognostic effect of lymph nodes metastasis in aortopulmonary (AP) zone in resected non-small cell lung cancer of the left upper lobe (LUL).

METHODS

Between 1998 and 2010, 181 patients with LUL carcinoma underwent complete resection and were retrospectively analyzed. The patients were divided into four groups according to N status: N0 (n = 68, 37.6%), N1 (n = 64, 35.3%), N2(5,6+) (only metastasized to stations 5 and/or 6, n = 36, 19.9%), and N2(7+) (only metastasized to stations 7, n = 13, 7.2%). N1 were divided according to single and multiple (N1(single) n = 49, N1(multiple) n = 15) or peripheral and hilar (N1(peripheral) n = 39, N1(hilar) n = 25).

RESULTS

Overall 5-year survival rate was 55.1%. Five-year survivals were 76.1% for N0, 54.3% for N1, and 20.7% for N2. N1(peripheral) had a better survival than N1(hilar) (60.3 vs. 29.4%, p = 0.09). Five-year survival of N1(single) was 60.1%, whereas it was 36.6% for N1(multiple) (p = 0.02). Five-year survival rate was 24.6% for N2(5,6+). Skip metastasis for lymph nodes in AP zone (n = 13) was a factor of better prognosis as compared to nonskip metastasis (n = 23) (29.9 vs. 19.2%). There was no statistically significant difference between the N2(5,6+) and N1(hilar) (p = 0.772), although N1(peripheral) had a significantly better survival than N2(5,6+) (p = 0.02). AP zone metastases alone had a significantly worse survival than N1(single) (p = 0.008), whereas there was no statistically significant difference between the N1(multiple) and N2(5,6+) (p = 0.248). N2(7+) was not expected to survive 3 years after operation. They had a significantly worse prognosis than N2(5,6+) (p = 0.02).

CONCLUSION

LUL tumors with metastasis in the AP zone lymph nodes, especially skip metastasis, were associated with a more favorable prognosis than other mediastinal lymph nodes. However, the therapy of choice for lung cancer with N2(5,6+) has not been clarified yet.

摘要

引言

我们研究了主动脉肺（AP）区淋巴结转移对左上叶（LUL）切除的非小细胞肺癌的预后影响。

方法

1998年至2010年间，181例LUL癌患者接受了根治性切除，并进行回顾性分析。根据N分期将患者分为四组：N0（n = 68，37.6%）、N1（n = 64，35.3%）、N2(5,6+)（仅转移至第5和/或6组淋巴结，n = 36，19.9%）和N2(7+)（仅转移至第7组淋巴结，n = 13，7.2%）。N1根据单个和多个（N1(单个) n = 49，N1(多个) n = 15）或外周和肺门（N1(外周) n = 39，N1(肺门) n = 25）进行分组。

结果

总体5年生存率为55.1%。N0的5年生存率为76.1%，N1为54.3%，N2为20.7%。N1(外周)的生存率优于N1(肺门)（60.3%对29.4%，p = 0.09）。N1(单个)的5年生存率为60.1%，而N1(多个)为36.6%（p = 0.02）。N2(5,6+)的5年生存率为24.6%。AP区淋巴结跳跃转移（n = 13）与非跳跃转移（n = 23）相比是预后较好的一个因素（29.9%对19.2%）。N2(5,6+)与N1(肺门)之间无统计学显著差异（p = 0.772），尽管N1(外周)的生存率显著优于N2(5,6+)（p = 0.02）。单独的AP区转移生存率显著低于N1(单个)（p = 0.008），而N1(多个)与N2(5,6+)之间无统计学显著差异（p = 0.248）。N2(7+)预计术后3年无法生存。其预后显著差于N2(5,6+)（p = 0.02）。