Wang Xing, Yan Shi, Phan Kevin, Yan Tristan D, Zhang Lijian, Yang Yue, Wu Nan
1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
J Thorac Dis. 2016 Mar;8(3):342-9. doi: 10.21037/jtd.2016.02.49.
This retrospective study investigated whether mediastinal lymphadenectomy compliant with the National Comprehensive Cancer Network (NCCN) criteria will improve the oncological outcomes of clinical early-stage lung cancer.
From 2003-2010, 712 consecutive cases of clinical N0/1 were included for retrospective analysis, including 152 confirmed cases of pN2 and 560 of pN0-1 disease following surgery. Group A was defined as the cases fulfilling NCCN lymphadenectomy criteria (≥ three stations of N2 nodes dissection) and group B included all other cases. The groups were stratified according to pN status and the outcomes were assessed.
Five-year overall survival (OS) and 5-year disease-free survival (DFS) were significantly different between group A versus B [72%±2% vs. 63%±4% (OS), P=0.014; 58.0%±2% vs. 49%±4% (DFS), P=0.038] in the whole cohort. After stratification by pN status, this difference was remained in pN2 subgroup [50%±5% vs. 25%±9% (OS), P=0.006; 31.0%±4% vs. 13%±7% (DFS), P=0.014], but not in pN0-1 subgroups. Cox regression analysis showed that performing a lymphadenectomy fulfilling NCCN criteria was a significant prognostic factor for OS either in the whole cohort [P=0.003, hazard ratio (HR): 0.598, 95% confidence interval (CI): 0.425-0.841] or in patients of pN2 status (P=0.038, HR: 0.559, 95% CI: 0.323-0.968). Cases with ≥4 N2 stations dissected did not achieve better survival benefit compared to those harvesting 3 stations in cN0/1-pN2 group (P=0.152).
Mediastinal lymphadenectomy fulfilling NCCN criteria appears to improve the survival of unexpected N2 group (cN0/1-pN2) among early-stage lung cancer patients. More extended N2 node dissection may not further improve the outcome in this group.
本回顾性研究调查了符合美国国立综合癌症网络（NCCN）标准的纵隔淋巴结清扫术是否会改善临床早期肺癌的肿瘤学结局。
2003年至2010年，纳入712例连续的临床N0/1期病例进行回顾性分析，包括术后确诊为pN2的152例病例和pN0-1疾病的560例病例。A组定义为符合NCCN淋巴结清扫标准（≥3站N2淋巴结清扫）的病例，B组包括所有其他病例。根据pN状态对两组进行分层并评估结局。
在整个队列中，A组与B组的5年总生存率（OS）和5年无病生存率（DFS）有显著差异[72%±2%对63%±4%（OS），P=0.014；58.0%±2%对49%±4%（DFS），P=0.038]。按pN状态分层后，这种差异在pN2亚组中仍然存在[50%±5%对25%±9%（OS），P=0.006；31.0%±4%对13%±7%（DFS），P=0.014]，但在pN0-1亚组中不存在。Cox回归分析表明，在整个队列中[P=0.003，风险比（HR）：0.598，95%置信区间（CI）：0.425-0.841]或pN2状态的患者中（P=0.038，HR：0.559，95%CI：0.323-0.968），进行符合NCCN标准的淋巴结清扫术是OS的显著预后因素。在cN0/1-pN2组中，清扫≥4站N2淋巴结的病例与清扫3站的病例相比，未获得更好的生存获益（P=0.152）。
符合NCCN标准的纵隔淋巴结清扫术似乎可改善早期肺癌患者意外N2组（cN0/1-pN2）的生存率。更广泛的N2淋巴结清扫可能不会进一步改善该组的结局。
