Shen-Tu Yang, Mao Feng, Pan Yan, Wang Wenli, Zhang Liang, Zhang Hui, Cheng Baijun, Guo Haifa, Wang Zhiqiang
Department of Thoracic Surgery Department of Pharmacology, Shanghai Chest Hospital, Shanghai Jiao Tong University Department of Thoracic Surgery, Tongji Hospital, Tongji University, Shanghai Department of Thoracic Oncology Medicine, Jilin Tumor Hospital, Changchun, Jilin Province Department of Thoracic Oncology Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China Centre for Clinical Research, Faculty of Medicine, University of Queensland, Australia.
Medicine (Baltimore). 2017 Oct;96(43):e8356. doi: 10.1097/MD.0000000000008356.
It is still debatable whether complete mediastinal lymph node dissection (MLND) is associated with better survival than mediastinal lymph node sampling (MLNS) in surgical treatment of nonsmall cell lung cancer (NSCLC). We aimed to assess the impact of lymph node dissection on long-term survival among stage I NSCLC patients.In this cohort study, 317 stage I NSCLC Chinese patients in Shanghai Chest Hospital were followed up for at least 10 years to evaluate the impact of different lymph node dissection modes on their survival. Among them, 161 patients were in the MLND group and 156 in the MLNS group. Overall survival and median survival times were calculated for the 2 groups. The association between lymph node dissection and the survival of NSCLC patients was assessed using Cox proportional-hazard models.Patients in the MLND group presented better survival (median survival time = 154.67 months) than those in the MLNS group (median survival time = 124.67 months). The MLNS had higher mortality than the MLND group, with the crude hazard ratio of the MLNS group relative to the MLND group as 1.32 (95% confidence interval [CI] 0.97, 1.78). After adjusting for age and sex, the association between lymph node dissection and mortality (hazard ratio 1.36, 95% CI 1.00, 1.84) was statistically significant (P = .047). Further adjusting for baseline clinical characteristics, the association (hazard ratio 1.40, 95% CI 1.02, 1.92) remained statistically significant (P = .036). The association between lymph node dissection mode and mortality was strong among patients with tumor size between 2.0 and 3.0 cm (hazard ratio 2.79, 95% CI 1.45, 5.37).We found that the MLND was associated with better survival for patients with early-stage NSCLC, compared with the MLNS. The effects of MLND on survival may depend on tumor size. Our findings have important implications in the treatment of early-stage NSCLC. Further prospective studies with a large sample size are needed to confirm our findings.
在非小细胞肺癌（NSCLC）的外科治疗中，完全纵隔淋巴结清扫术（MLND）是否比纵隔淋巴结采样术（MLNS）能带来更好的生存率仍存在争议。我们旨在评估淋巴结清扫对I期NSCLC患者长期生存的影响。在这项队列研究中，对上海胸科医院的317例I期NSCLC中国患者进行了至少10年的随访，以评估不同淋巴结清扫方式对其生存的影响。其中，161例患者在MLND组，156例在MLNS组。计算了两组的总生存时间和中位生存时间。使用Cox比例风险模型评估淋巴结清扫与NSCLC患者生存之间的关联。MLND组患者的生存情况（中位生存时间 = 154.67个月）优于MLNS组（中位生存时间 = 124.67个月）。MLNS组的死亡率高于MLND组，MLNS组相对于MLND组的粗风险比为1.32（95%置信区间[CI] 0.97, 1.78）。在调整年龄和性别后，淋巴结清扫与死亡率之间的关联（风险比1.36，95% CI 1.00, 1.84）具有统计学意义（P = 0.047）。进一步调整基线临床特征后，该关联（风险比1.40，95% CI 1.02, 1.92）仍具有统计学意义（P = 0.036）。在肿瘤大小为2.0至3.0 cm的患者中，淋巴结清扫方式与死亡率之间的关联很强（风险比2.79，95% CI 1.45, 5.37）。我们发现，与MLNS相比，MLND与早期NSCLC患者的更好生存相关。MLND对生存的影响可能取决于肿瘤大小。我们的发现对早期NSCLC的治疗具有重要意义。需要进一步进行大样本量的前瞻性研究来证实我们的发现。
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