Wang Xinxin, Guo Haixie, Hu Quanteng, Ying Yongquan, Chen Baofu
Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China.
Front Surg. 2021 Oct 12;8:749156. doi: 10.3389/fsurg.2021.749156. eCollection 2021.
The skip N2 metastases were frequent in non-small-cell lung cancer (NSCLC) and the better prognosis of NSCLC with a skip over non-skip N2 lymph node metastases is controversial. The primary aim of this study is to investigate the prognosis effect of skip N2 lymph node metastases on the survival of NSCLC. A literature search was conducted in PubMed, EMBASE, and Cochrane Library with the term of "N2" or "mediastinal lymph node" or "mediastinal nodal metastases", and "lung cancer" and "skip" or "skipping" in the title/abstract field. The primary outcomes of interests are 3- and 5-year survival in NSCLC. Patients who underwent complete resection by lobectomy, bilobectomy, or pneumonectomy with systemic ipsilateral lymphadenectomy and were staged as pathologically N2 were included. The 3- and 5-year survival of NSCLC was analyzed. The impact of publication year, number of patients, baseline mean age, gender, histology, adjuvant therapy, number of skip N2 stations, and survival analysis methods on the primary outcome were also analyzed. A total of 21 of 409 studies with 6,806 patients met the inclusion criteria and were finally included for the analysis. The skip N2 lymph node metastases NSCLC had a significantly better overall survival (OS) than the non-skip N2 NSCLC [hazard ratio (HR), 0.71; 95% CI, 0.62-0.82; < 0.001; = 40.4%]. The skip N2 lymph node metastases NSCLC had significantly higher 3- and 5-year survival rates than the non-skip N2 lymph node metastases NSCLC (OR, 0.75; 95% CI, 0.66-0.84; < 0.001; = 60%; and OR, 0.78; 95% CI, 0.71-0.86; < 0.001; = 67.1%, respectively). This meta-analysis suggests that the prognosis of skip N2 lymph node metastases NSCLC is better than that of a non-skip N2 lymph node.
跳跃性N2转移在非小细胞肺癌（NSCLC）中很常见，而NSCLC伴有跳跃性N2淋巴结转移较非跳跃性N2淋巴结转移有更好的预后这一观点存在争议。本研究的主要目的是探讨跳跃性N2淋巴结转移对NSCLC患者生存的预后影响。在PubMed、EMBASE和Cochrane图书馆进行文献检索，检索词为标题/摘要字段中的“N2”或“纵隔淋巴结”或“纵隔淋巴结转移”，以及“肺癌”和“跳跃性”或“跳跃”。感兴趣的主要结局是NSCLC患者的3年和5年生存率。纳入接受肺叶切除术、双肺叶切除术或全肺切除术加同侧系统性淋巴结清扫且病理分期为N2的患者。分析NSCLC患者的3年和5年生存率。还分析了发表年份、患者数量、基线平均年龄、性别、组织学、辅助治疗、跳跃性N2站数量和生存分析方法对主要结局的影响。409项研究中的21项共6806例患者符合纳入标准，最终纳入分析。跳跃性N2淋巴结转移的NSCLC患者总生存期（OS）显著优于非跳跃性N2的NSCLC患者[风险比（HR），0.71；95%置信区间（CI），0.62 - 0.82；P < 0.001；I² = 40.4%]。跳跃性N2淋巴结转移的NSCLC患者3年和5年生存率显著高于非跳跃性N2淋巴结转移的NSCLC患者（OR，0.75；95% CI，0.66 - 0.84；P < 0.001；I² = 60%；以及OR，0.78；95% CI，0.71 - 0.86；P < 0.001；I² = 67.1%）。这项荟萃分析表明，跳跃性N2淋巴结转移的NSCLC患者预后优于非跳跃性N2淋巴结转移患者。
