Department of Lung Transplantation, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
BMC Surg. 2022 Apr 29;22(1):153. doi: 10.1186/s12893-022-01605-z.
Lung adenocarcinoma is the most common subtype of non-small cell lung cancer. The surgical strategy of lymph node dissection is controversial because many more patients are diagnosed at an early stage in clinical practice.
We retrospectively reviewed 622 clinical N0 lung adenocarcinoma patients with 3 cm or less in tumor size who underwent lobectomy or segmentectomy combined with lymph node dissection in our hospital from January 2017 to December 2019. We performed univariate and multivariate analyses to identify preoperative risk factors of lymph node metastasis.
Lymph node metastasis was found in 60 out of 622 patients. On univariate analysis, lymph node metastasis was linked to smoking history, preoperative CEA level, tumor size, tumor location (peripheral or central), consolidation/tumor ratio, pleural invasion, and pathologic type. However, only the preoperative CEA level, tumor size, and consolidation/tumor ratio were independent risk factors in multivariate analysis. The ROC curve showed that the cutoff value of tumor size was 1.7 cm. There was no lymph node metastasis in patients without risk factors.
The preoperative CEA level, tumor size, and consolidation/tumor ratio were independent risk factors of lymph node metastasis in clinical N0 lung adenocarcinoma with tumor size ≤ 3 cm. The lymph node metastasis rate was extremely low in clinical N0 lung adenocarcinoma patients without risk factors and lymph node dissection should be avoided in these patients to reduce surgical trauma.
肺腺癌是非小细胞肺癌中最常见的亚型。由于在临床实践中，更多的患者被诊断为早期，因此淋巴结清扫的手术策略存在争议。
我们回顾性分析了 2017 年 1 月至 2019 年 12 月在我院行肺叶切除术或段切除术联合淋巴结清扫的 622 例临床 N0 肺腺癌患者，肿瘤大小均≤3cm。我们进行单因素和多因素分析，以确定淋巴结转移的术前危险因素。
622 例患者中有 60 例发现淋巴结转移。单因素分析显示，淋巴结转移与吸烟史、术前 CEA 水平、肿瘤大小、肿瘤位置（外周或中央）、实变/肿瘤比、胸膜侵犯和病理类型有关。然而，多因素分析仅显示术前 CEA 水平、肿瘤大小和实变/肿瘤比是独立的危险因素。ROC 曲线显示肿瘤大小的截断值为 1.7cm。无危险因素的患者无淋巴结转移。
对于肿瘤大小≤3cm 的临床 N0 肺腺癌，术前 CEA 水平、肿瘤大小和实变/肿瘤比是淋巴结转移的独立危险因素。无危险因素的临床 N0 肺腺癌患者淋巴结转移率极低，应避免淋巴结清扫，以减少手术创伤。
