Moon Youngkyu, Sung Sook Whan, Namkoong Min, Park Jae Kil
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2016 Sep;8(9):2617-2625. doi: 10.21037/jtd.2016.08.75.
The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC.
We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.
Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% . 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987]. GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.
MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.
表现为磨玻璃密度（GGO）结节的非小细胞肺癌（NSCLC）的预后优于其他类型的肺癌。本研究的目的是评估在临床N0、以GGO为主的NSCLC中进行纵隔淋巴结评估（MLE）的必要性。
我们对358例接受临床N0 NSCLC治疗的患者进行了回顾性病历审查，这些患者经根治性切除发现肿瘤大小为3 cm或更小。我们分析了以GGO为主或实性为主的肿瘤的三组患者的临床病理特征和生存率：未进行纵隔淋巴结评估（NoMLE）组、纵隔淋巴结采样（MLS）组和纵隔淋巴结清扫（MLND）组。
除性别外，以GGO为主的肿瘤组或实性为主的肿瘤组的三组患者在临床病理特征上无差异。在以GGO为主的患者中，三组的5年无复发生存率（RFS）无差异（分别为100%、92.9%、93.8%；P = 0.889）。然而，在实性为主的肿瘤组中，NoMLE组的5年无复发生存率低于MLND组（48.6%对73.1%，P = 0.007）。MLE不是以GGO为主的肿瘤复发的显著危险因素[风险比（HR）= 1.021；P = 0.987]。以GGO为主的肿瘤[优势比（OR）= 0.063；P = 0.008]被确定为显著影响淋巴结分期升级的唯一参数。
对于表现为3 cm或更小、以GGO为主的结节的临床N0 NSCLC，MLE不是必需的操作。
