Boada Marc, Sánchez-Lorente David, Libreros Alejandra, Lucena Carmen M, Marrades Ramón, Sánchez Marcelo, Paredes Pilar, Serrano Mario, Guirao Angela, Guzmán Rudith, Viñolas Núria, Casas Francesc, Agustí Carles, Molins Laureano
Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.
Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
J Thorac Dis. 2020 Aug;12(8):3976-3986. doi: 10.21037/jtd-20-1248.
Tumor involvement of mediastinal lymph nodes is of high importance in non-small cell lung cancer (NSCLC). Invasive mediastinal staging is recommended in selected patients without evidence of mediastinal involvement on staging by imaging. In the present study we aimed to evaluate the effectiveness of invasive mediastinal staging in reducing pN2, its impact on survival and the risk factors for occult pN2.
Patients with NSCLC tumors larger than 3 cm, central tumors or cN1 cases treated in our institution between 2013 and 2018 were prospectively included in the study. Incidence of pN2 and overall survival was compared among invasively staged (IS) and non-invasively staged groups (NIS). Multivariate analysis was performed to identify risk factors of pN2.
A total of 201 patients were included in the study, 79 (39.3%) of whom were not invasively staged (NIS group) and 122 (60.7%) were invasively staged (IS group). Incidence of cN1 and mean PET/CT uptake was different among both groups. Prevalence of pN2 was similar in both groups (7.6% in NIS 12.6% in IS; P>0.05). Median survival in IS-pN2 patients was 11 months longer than in NIS-pN2 group (33.6 22.5 months; P=0.245). cN1 emerged as the only a risk factor for pN2.
Invasive staging does not reduce the incidence of pN2. However, this finding could be biased because in our series cN1 patients were more often staged and cN1 has been detected as a risk factor for pN2. In addition patient better selection after invasive staging might have an impact on overall survival. To conclude, invasive mediastinal staging in intermediate risk patients for positive mediastinal nodes is justified.
纵隔淋巴结受累在非小细胞肺癌（NSCLC）中具有高度重要性。对于影像学分期未显示纵隔受累证据的特定患者，建议进行有创纵隔分期。在本研究中，我们旨在评估有创纵隔分期在降低pN2方面的有效性、其对生存的影响以及隐匿性pN2的危险因素。
前瞻性纳入2013年至2018年在我院接受治疗的肿瘤直径大于3 cm的NSCLC患者、中央型肿瘤患者或cN1病例。比较有创分期（IS）组和无创分期组（NIS）的pN2发生率和总生存率。进行多因素分析以确定pN2的危险因素。
本研究共纳入201例患者，其中79例（39.3%）未进行有创分期（NIS组），122例（60.7%）进行了有创分期（IS组）。两组的cN1发生率和平均PET/CT摄取不同。两组的pN2患病率相似（NIS组为7.6%，IS组为12.6%；P>0.05）。IS-pN2患者的中位生存期比NIS-pN2组长11个月（33.6个月对22.5个月；P=0.245）。cN1是pN2的唯一危险因素。
有创分期并未降低pN2的发生率。然而，这一发现可能存在偏差，因为在我们的系列研究中，cN1患者更常进行分期，且cN1已被检测为pN2的危险因素。此外，有创分期后更好地选择患者可能会对总生存产生影响。总之，对于纵隔淋巴结转移风险中等的患者，有创纵隔分期是合理的。
