Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey.
Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey.
Ann Thorac Cardiovasc Surg. 2021 Oct 20;27(5):304-310. doi: 10.5761/atcs.oa.20-00289. Epub 2021 Mar 31.
In this study, we aimed to reveal the prognostic differences between skip and non-skip metastasis mediastinal lymph node (MLN) metastasis.
A total of 202 patients (179 males and 23 females; mean age, 59.66 ± 9.89 years; range: 29-84 years) who had ipsilateral single-station MLN metastasis were analyzed in two groups retrospectively between January 2009 and December 2017: "skip ipsilateral MLN metastasis" group (sN2) (n = 55,27.3%) [N1(-), N2(+)], "non-skip ipsilateral MLN metastasis" group (nsN2) (n = 147,72.7%) [N1(+), N2(+)].
The mean follow-up was 42.63 ± 34.91 months (range: 2-117 months). Among all patients, and in the sN2 and nsN2 groups, the median overall survival times were 63.5 ± 4.56, 68.8 ± 7, and 59.3 ± 5.35 months, respectively, and the 5-year overall survival rates were 38.2%, 46.3%, and 36.4%.
Skip metastasis did not take its rightful place in TNM classification; thus, further studies will be performed. To detect micrometastasis, future studies on skip metastasis should examine non-metastatic hilar lymph nodes (LNs) through staining methods so that heterogeneity in patient groups can be avoided, that is, to ensure that only true skip metastasis cases are included. Afterwards, more accurate and elucidative studies on skip metastasis can be achieved to propound its prognostic importance in the group of N2 disease.
本研究旨在揭示跳跃性与非跳跃性纵隔淋巴结（MLN）转移患者的预后差异。
回顾性分析 2009 年 1 月至 2017 年 12 月期间 202 例（男 179 例，女 23 例；平均年龄 59.66±9.89 岁；年龄范围：29-84 岁）同侧单站 MLN 转移患者，分为两组：“跳跃性同侧 MLN 转移”组（sN2）（n=55，27.3%）[N1(-)，N2(+)]，“非跳跃性同侧 MLN 转移”组（nsN2）（n=147，72.7%）[N1(+)，N2(+)]。
所有患者的中位随访时间为 42.63±34.91 个月（范围：2-117 个月）。在所有患者中，以及在 sN2 和 nsN2 组中，中位总生存期分别为 63.5±4.56、68.8±7 和 59.3±5.35 个月，5 年总生存率分别为 38.2%、46.3%和 36.4%。
跳跃性转移并未在 TNM 分期中占据应有的位置；因此，需要进一步研究。为了检测微转移，未来对跳跃性转移的研究应通过染色方法检查非转移性肺门淋巴结（LN），以避免患者组的异质性，即确保仅纳入真正的跳跃性转移病例。之后，可以对跳跃性转移进行更准确和有启发性的研究，以提出其在 N2 疾病组中的预后重要性。
