Han Lu, Jia Hui, Song Pingping, Liu Xibin, Wang Zhendan, Zhang Dujian
Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Department of Respiratory Internal, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Med (Lausanne). 2022 Aug 30;9:960689. doi: 10.3389/fmed.2022.960689. eCollection 2022.
Hilar and lung lymph node metastases (N1) are defined as ipsilateral bronchial and intrapulmonary lymph nodes. However, the cleaning standards for ipsilateral bronchial lymph nodes in different lobes and segments within the same lobe in segmentectomy are not clearly defined.
Sixty-six patients undergoing pulmonary resection for the treatment of lung cancer were evaluated. Intraoperatively visible non-tumor-bearing lobe (NTBL) and post-operatively non-tumor-bearing segment (NTBS) lymph nodes were removed and analyzed. The associations between the NTBL LNs and clinicopathological characteristics were analyzed.
Non-tumor-bearing lobe LNs metastases were found in 8 (12.1%) of the 66 patients, NTBS LNs metastasis were not found (0/13). The presence of NTBL metastases was significantly associated with age (<60 years vs. ≥60 years, = 0.037), differentiation (Grade 1 well differentiated vs. Grade 2 moderately differentiated vs. Grade 3 poorly differentiated, = 0.012), CAT-scan-findings of Mediastinal and hilar lymph nodes metastasis (node-positive vs. node-negative, = 0.022), pN stage (N0 vs. N1 vs. N2, = 0.003) and p stage (I vs. II vs. III, = 0.009). Multivariate logistic analysis showed that tumor differentiation ( = 0.048, HR 6.229; 95% CI 1.016-38.181) and pN ( = 0.024, HR 5.099; 95% CI 1.245-20.878) were statistically significant predictors.
Lobar lymph node metastasis of NTBL occurs frequently in patients with NSCLC, but lymph node metastases in NTBS LNs are rare. Advanced age, poorly differentiated and N1 and N2 status of CAT-scan-findings were independent risk factors for the involvement of the NTBL lobar lymph nodes. Although lymph node metastases in NTBS are rare, further investigation of the need to dissect is required.
肺门及肺淋巴结转移（N1）定义为同侧支气管及肺内淋巴结转移。然而，在肺段切除术中，同一肺叶不同肺段的同侧支气管淋巴结清扫标准尚不明确。
对66例因肺癌接受肺切除术的患者进行评估。术中切除并分析可见的无瘤肺叶（NTBL）及术后无瘤肺段（NTBS）淋巴结。分析NTBL淋巴结转移与临床病理特征之间的相关性。
66例患者中有8例（12.1%）发现无瘤肺叶淋巴结转移，未发现NTBS淋巴结转移（0/13）。NTBL转移的存在与年龄（<60岁 vs.≥60岁，P = 0.037）、分化程度（1级高分化 vs. 2级中分化 vs. 3级低分化，P = 0.012）、胸部CT扫描发现的纵隔及肺门淋巴结转移情况（淋巴结阳性 vs. 淋巴结阴性，P = 0.022）、pN分期（N0 vs. N1 vs. N2，P = 0.003）及p分期（I期 vs. II期 vs. III期，P = 0.009）显著相关。多因素logistic分析显示，肿瘤分化程度（P = 0.048，HR 6.229；95%CI 1.016 - 38.181）及pN（P = 0.024，HR 5.099；95%CI 1.245 - 20.878）是具有统计学意义的预测因素。
非小细胞肺癌患者中无瘤肺叶淋巴结转移较为常见，但无瘤肺段淋巴结转移罕见。高龄、低分化以及胸部CT扫描发现的N1和N2状态是无瘤肺叶淋巴结受累的独立危险因素。尽管无瘤肺段淋巴结转移罕见，但仍需进一步研究是否有必要进行清扫。
