Department of Thoracic Surgery, University Hospital of Zurich, Switzerland.
Universitätsspital Zürich- Thoraxchirurgie.
Swiss Med Wkly. 2021 Feb 4;151:w20385. doi: 10.4414/smw.2021.20385. eCollection 2021 Feb 1.
We aimed to analyse the nodal spread of our non-small cell lung cancer pN2 cohort according to tumour location, the possible implications of an unusual spreading pattern, and other factors influencing postoperative survival after anatomical lung resection.
In this retrospective observational study, clinical data was collected for 124 consecutive non-small cell lung cancer (NSCLC) patients with a pathological N2 (stage IIIA or B) undergoing anatomical lung resection at our institution between 2001 and 2010. Cox regression was used to analyse independent predictors of 5-year overall survival and recurrence-free survival.
A total of 105 patients were included in the final analysis. Tumour location in the right upper lobe and middle lobe was significantly more often associated with involvement of lymph node stations 2 and 4 than NSCLC in the right lower lobe (station 2: right upper vs right lower lobe, p = 0.001 and middle vs right lower lobe, p = 0.038; station 4: right upper vs right lower lobe, p<0.001 and middle vs right lower lobe, p = 0.056), while tumours in the right upper lobe showed significantly less involvement of stations 7 and 8 compared with right lower lobe tumours (station 7 p <0.001, station 8 p = 0.004). Left sided tumours in the upper lobe had significantly more involvement of station 5 compared to lower lobe tumours (p = 0.009). However, atypical lymphatic nodal zone involvement did not emerge as a significant predictor of survival. Lymphovascular invasion was the only independent prognostic factor for 5-year overall survival (hazard ratio [HR] 2.10, p = 0.015) and recurrence-free survival (HR 1.68, p = 0.049) when controlled for adjuvant therapy.
Lymphovascular invasion was identified as the only independent prognostic factor for 5-year overall survival and recurrence-free survival in our pathologically proven N2 NSCLC cohort when controlled for adjuvant therapy. This study extends the current evidence of an adverse prognostic effect of lymphovascular invasion on a stage III population, confirms the adverse prognostic effect of lymphovascular invasion detected by immunohistochemistry, and thereby reveals another subgroup within the pN2 population with worse prognosis regarding 5-year overall survival and recurrence-free survival.  .
我们旨在根据肿瘤位置分析非小细胞肺癌 pN2 队列的淋巴结转移情况，探讨不常见的扩散模式的可能影响，并分析其他影响解剖性肺切除术后生存的因素。
本回顾性观察研究收集了 2001 年至 2010 年间在我院接受解剖性肺切除的 124 例连续非小细胞肺癌（NSCLC）患者的临床资料，这些患者的病理分期为 N2（III 期 A 或 B）。采用 Cox 回归分析 5 年总生存率和无复发生存率的独立预测因素。
共纳入 105 例患者进行最终分析。与右下叶 NSCLC 相比，右上叶和中叶的肿瘤位置与淋巴结站 2 和 4 的受累显著相关（站 2：右上叶与右下叶相比，p = 0.001；中叶与右下叶相比，p = 0.038；站 4：右上叶与右下叶相比，p <0.001；中叶与右下叶相比，p = 0.056），而上叶肿瘤的 7 站和 8 站受累明显少于右下叶肿瘤（站 7 p <0.001，站 8 p = 0.004）。左肺上叶肿瘤的 5 站受累明显多于下叶肿瘤（p = 0.009）。然而，非典型的淋巴结区域受累并未成为生存的显著预测因素。血管侵犯是控制辅助治疗后 5 年总生存率（风险比[HR]2.10，p = 0.015）和无复发生存率（HR 1.68，p = 0.049）的唯一独立预后因素。
当控制辅助治疗时，血管侵犯被确定为我们经病理证实的 N2 NSCLC 队列中 5 年总生存率和无复发生存率的唯一独立预后因素。这项研究扩展了当前关于血管侵犯对 III 期人群不良预后影响的证据，证实了免疫组织化学检测到的血管侵犯的不良预后影响，并因此揭示了 pN2 人群中另一个 5 年总生存率和无复发生存率较差的亚组。
