右原发性非小细胞肺癌患者 4R 淋巴结清扫的预后意义。
Prognostic significance of 4R lymph node dissection in patients with right primary non-small cell lung cancer.
机构信息
Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Binshui Road, Tianjin, China.
出版信息
World J Surg Oncol. 2022 Jul 1;20(1):222. doi: 10.1186/s12957-022-02689-w.
BACKGROUND
To investigate the prognostic significance of station 4R lymph node (LN) dissection in patients who underwent operations for right primary non-small cell lung cancer (NSCLC).
METHODS
We performed a retrospective study involving patients with right primary NSCLC who received lobotomy or pneumonectomy with mediastinal LN dissection between January 2011 and December 2017. Propensity score matching was performed. Disease-free survival (DFS) and overall survival (OS) were compared between patients with and without station 4R dissection.
RESULTS
Our study included 2070 patients, with 207 patients having no station 4R dissection (S4RD- group) and 1863 patients having station 4R dissection (S4RD+ group). The 4R LN metastasis rate was 13.4% (142/1748), higher than that for other mediastinal LN metastases. Compared with the S4RD- group, the S4RD+ group had higher 5-year DFS (48.1% vs. 39.1%, P = 0.009) and OS (54.4% vs. 42.8%, P = 0.025). Station 4R dissection was an independent risk factor for DFS (odds ratio, OR, 1.28, 95% confidence interval, CI, 1.08-1.64, P = 0.007) and OS (OR 1.31, 95% CI 1.04-1.63, P = 0.018). Patients with adjuvant chemotherapy had a better prognosis after station 4R dissection than those without adjuvant chemotherapy (57.4% vs. 52.3%, P = 0.006). The 5-year OS in the station 4R metastasis group was lower than that in the station 4R non-metastasis group (26.9% vs. 44.3%, P = 0.006) among N2 patients. The 5-year OS of the single-station 4R metastasis group was lower than that of the single-station 7 metastasis group (15.7% vs. 51.6%, P = 0.002).
CONCLUSIONS
Station 4R metastasis was the highest among all the mediastinal station metastases in right primary NSCLC patients. Station 4R dissection can improve the prognosis and should be recommended as a routine procedure for these patients.
背景
研究右肺原发性非小细胞肺癌（NSCLC）患者行 4R 淋巴结清扫术的预后意义。
方法
我们进行了一项回顾性研究，纳入 2011 年 1 月至 2017 年 12 月期间接受肺叶切除术或全肺切除术及纵隔淋巴结清扫术的右肺原发性 NSCLC 患者。采用倾向评分匹配法进行分析。比较有和无 4R 清扫术患者的无病生存期（DFS）和总生存期（OS）。
结果
共纳入 2070 例患者，其中 207 例未行 4R 清扫术（S4RD-组），1863 例行 4R 清扫术（S4RD+组）。4R 淋巴结转移率为 13.4%（142/1748），高于其他纵隔淋巴结转移。与 S4RD-组相比，S4RD+组的 5 年 DFS（48.1% vs. 39.1%，P=0.009）和 OS（54.4% vs. 42.8%，P=0.025）更高。4R 清扫术是 DFS（比值比[OR]，1.28，95%置信区间[CI]，1.08-1.64，P=0.007）和 OS（OR，1.31，95%CI，1.04-1.63，P=0.018）的独立危险因素。有辅助化疗的患者行 4R 清扫术的预后优于无辅助化疗者（57.4% vs. 52.3%，P=0.006）。N2 患者中，4R 淋巴结转移组的 5 年 OS 低于 4R 淋巴结未转移组（26.9% vs. 44.3%，P=0.006）。单站 4R 转移组的 5 年 OS 低于单站 7 转移组（15.7% vs. 51.6%，P=0.002）。
结论
右肺原发性 NSCLC 患者纵隔各站中，4R 站转移率最高。4R 清扫术可改善预后，应作为该类患者的常规术式。
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