Wang Shao Dong, Liu Gan Wei, Li Xiao, Sui Xi Zhao, Yang Fan, Wang Jun
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Ann Thorac Surg. 2021 Jan;111(1):277-282. doi: 10.1016/j.athoracsur.2020.05.027. Epub 2020 Jun 23.
The clinical relevance of the highest mediastinal lymph node (HMLL) metastasis in patients with pathological N2 non-small cell lung cancer (NSCLC) is still controversial. Our study aimed to reassess the effect of HMLL metastasis on survival.
Patients with stage pT1-4N2M0 NSCLC who underwent major lung resection and systemic lymphadenectomy at Peking University People's Hospital from 2004 to 2015 were identified. Patients in the HMLL-positive group were matched to patients in the HMLL-negative group using 1:1 propensity score matching analysis. Overall survival was estimated by Kaplan-Meier method and compared using log-rank test, and multivariable Cox proportional hazard regression was constructed to identify risk factors associated with overall survival. The cumulative incidence of cancer specific mortality was evaluated through a competing risk analysis.
A total of 266 NSCLC patients with stage pT1-4N2M0 NSCLC were enrolled. Of those, 128 cases were HMLL positive and 138 cases were HMLL negative. A higher proportion of patients in the HMLL-positive group were female (P = .034) and had a higher rate of adenocarcinoma (P = .003). Compared with the HMLL-negative, the HMLL-positive group was not associated with worse survival in unmatched cohorts (adjusted hazard ratio = 1.21; 95% confidence interval, 0.87-1.68). After propensity score matching, 109 pairs were selected. No survival difference remained in matched cohorts (adjusted hazard ratio = 1.00; 95% confidence interval, 0.70-1.42).
Highest mediastinal lymph node metastasis does not exhibit worse survival in patients with stage pT1-4N2M0 NSCLC. The clinical relevance of HMLL metastasis needs further examination.
在病理分期为N2的非小细胞肺癌（NSCLC）患者中，最高纵隔淋巴结（HMLL）转移的临床相关性仍存在争议。我们的研究旨在重新评估HMLL转移对生存的影响。
确定2004年至2015年期间在北京大学人民医院接受肺叶切除及系统性淋巴结清扫术的pT1-4N2M0期NSCLC患者。采用1:1倾向评分匹配分析，将HMLL阳性组患者与HMLL阴性组患者进行匹配。采用Kaplan-Meier法估计总生存期，并使用对数秩检验进行比较，构建多变量Cox比例风险回归模型以确定与总生存期相关的危险因素。通过竞争风险分析评估癌症特异性死亡率的累积发生率。
共纳入266例pT1-4N2M0期NSCLC患者。其中，128例HMLL阳性，138例HMLL阴性。HMLL阳性组女性患者比例较高（P = 0.034），腺癌发生率较高（P = 0.003）。与HMLL阴性组相比，在未匹配队列中，HMLL阳性组与较差的生存率无关（调整后风险比 = 1.21；95%置信区间，0.87-1.68）。倾向评分匹配后，选择了109对。在匹配队列中未观察到生存差异（调整后风险比 = 1.00；95%置信区间，0.70-1.42）。
在pT1-4N2M0期NSCLC患者中，最高纵隔淋巴结转移并未显示出较差的生存率。HMLL转移的临床相关性需要进一步研究。
