Fang Likui, Xu Jinming, Ye Bo, Yu Guocan, Chen Gang, Yang Jun
Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China.
Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
J Cardiothorac Surg. 2020 Feb 27;15(1):46. doi: 10.1186/s13019-020-1087-4.
This study aims to explore whether lobe specific lymph node dissection (LND) is adequate for cN0-1 non-small cell lung cancer (NSCLC) or not.
Among 5613 cN0-1 NSCLC patients, 394 cases (7.0%) with pN2 were enrolled and the distribution of mediastinal lymph node metastasis was analyzed. The included patients were divided into the non-lobe specific lymph node metastasis (NLSLNM) group and the lobe specific lymph node metastasis (LSLNM) group. The clinicopathological characteristics were compared between two groups and multivariable analysis was performed to find independent factors predicting NLSLNM.
The incidence of pN2 cases deserved serious attention. The proportion of upper zone lymph node metastases was not rare in right (55.0%) and left (35.7%) lower lobe tumors. The proportion of subcarinal zone lymph node involvement was also high in right (21.8%) and left (25.8%) upper lobe tumors. Multivariable analysis showed that elevated carcinoembryonic antigen (CEA) level (P = 0.034), right lower lobe (RLL) tumors (P = 0.022) and station 11 involvement (P = 0.030) were independent risk factors for NLSLNM.
Systematic LND seems to be superior to lobe specific LND in the assessment of lymph node status and high CEA level, RLL tumors and station 11 involvement are predictors for NLSLNM.
本研究旨在探讨肺叶特异性淋巴结清扫术（LND）对于cN0-1期非小细胞肺癌（NSCLC）是否足够。
在5613例cN0-1期NSCLC患者中，纳入394例（7.0%）pN2患者，分析纵隔淋巴结转移的分布情况。将纳入的患者分为非肺叶特异性淋巴结转移（NLSLNM）组和肺叶特异性淋巴结转移（LSLNM）组。比较两组的临床病理特征，并进行多变量分析以找出预测NLSLNM的独立因素。
pN2病例的发生率值得严重关注。在右下叶肿瘤中，上区淋巴结转移的比例在右侧（55.0%）和左侧（35.7%）并不少见。在右上叶肿瘤中，隆突下区淋巴结受累的比例在右侧（21.8%）和左侧（25.8%）也很高。多变量分析显示，癌胚抗原（CEA）水平升高（P = 0.034）、右下叶（RLL）肿瘤（P = 0.022）和第11组淋巴结受累（P = 0.030）是NLSLNM的独立危险因素。
在评估淋巴结状态方面，系统性LND似乎优于肺叶特异性LND，而CEA水平升高、RLL肿瘤和第11组淋巴结受累是NLSLNM的预测因素。
