Toosi Kavian, Velez-Cubian Frank O, Glover Jessica, Ng Emily P, Moodie Carla C, Garrett Joseph R, Fontaine Jacques P, Toloza Eric M
Morsani College of Medicine, Tampa, FL.
Department of Surgery, University of South Florida, Tampa, FL.
Surgery. 2016 Nov;160(5):1211-1218. doi: 10.1016/j.surg.2016.08.003. Epub 2016 Sep 21.
Mediastinal involvement in resected non-small-cell lung cancer mandates adjuvant therapy and affects survival. This study investigated lymph node dissection efficacy, lymph node metastasis detection, and survival after robotic-assisted lobectomy for non-small-cell lung cancer.
We retrospectively analyzed patients who underwent robotic-assisted lobectomy for non-small-cell lung cancer. Survival was assessed through chart reviews, Social Security Death Registry, and national obituary searches. Kaplan-Meier survival curves by clinical and pathologic stage were compared by log-rank and Cox regression analysis.
In 249 patients (mean age, 67.8 ± 0.6 years), mean individual mediastinal lymph nodes retrieved was 7.7 ± 0.3 lymph nodes, with mean of 13.9 ± 0.4 N1+ mediastinal lymph nodes. There were 159 (63.9%) clinical stage I versus 134 (53.8%) pathologic stage I patients, with 67 (26.9%) patients upstaged (20 cN0 to pN1; 17 cN0 to pN2; 4 cN1 to pN2) and 37 (14.9%) downstaged. One-year and 3-year survival rates, respectively, changed between clinical stage I (clinical stage I, 91% and 70%; clinical stage II, 80% and 64%; clinical stage III, 78% and 57%; clinical stage IV, 71% and 45%) and pathologic stage (pathologic stage I, 92% and 75%; clinical stage II, 83% and 73%; pathologic stage III, 75% and 44%; and pathologic stage IV, 67% and 0%).
Mediastinal lymph node dissection during robotic-assisted lobectomy adequately assesses lymph node stations and detects occult lymph node metastasis. Stage-specific survival is affected by upstaging.
纵隔受累的可切除非小细胞肺癌需要辅助治疗并影响生存。本研究调查了非小细胞肺癌机器人辅助肺叶切除术后的淋巴结清扫效果、淋巴结转移检测及生存情况。
我们回顾性分析了接受机器人辅助肺叶切除治疗非小细胞肺癌的患者。通过病历审查、社会保障死亡登记和全国讣告搜索评估生存情况。采用对数秩检验和Cox回归分析比较临床和病理分期的Kaplan-Meier生存曲线。
249例患者（平均年龄67.8±0.6岁），平均每例获取纵隔淋巴结7.7±0.3枚，N1+纵隔淋巴结平均为13.9±0.4枚。临床Ⅰ期患者159例（63.9%），病理Ⅰ期患者134例（53.8%），67例（26.9%）患者分期上调（20例cN0至pN1；17例cN0至pN2；4例cN1至pN2），37例（14.9%）患者分期下调。临床分期Ⅰ期（临床Ⅰ期，91%和70%；临床Ⅱ期，80%和64%；临床Ⅲ期，78%和57%；临床Ⅳ期，71%和45%）与病理分期（病理Ⅰ期，92%和75%；临床Ⅱ期，83%和73%；病理Ⅲ期，75%和44%；病理Ⅳ期，67%和0%）的1年和3年生存率分别有所变化。
机器人辅助肺叶切除术中的纵隔淋巴结清扫能充分评估淋巴结站别并检测隐匿性淋巴结转移。分期上调会影响特定分期的生存情况。
