Sayan Muhammet, Celik Ali, Kankoc Aykut, Akarsu Irmak, Aslan Muhammet Tarik, Kurtoglu Aysegul, Ahmedova Gunel, Tastepe Abdullah Irfan
Department of Thoracic Surgery, Gazi University, 06560, Ankara, Turkey.
Updates Surg. 2023 Dec;75(8):2335-2342. doi: 10.1007/s13304-023-01575-8. Epub 2023 Jun 29.
The optimum treatment option is surgery for clinical early stage non-small cell lung cancer. Despite all non-invasive and invasive staging effort, occult lymph-node metastasis can be detected in pathological staging. Here, we investigated whether there was any correlation between tumor diameter and occult lymph-node metastasis in N1 stations. Data of patient with non-small cell lung cancer clinical stage 1A were reviewed retrospectively. Those with tumor diameter smaller than 3 cm and pN0-pN1 in pathological staging were included in the study. Overall survival (OS) was calculated by Kaplan-Meier and survival differences between pN0 and pN1 groups were investigated by Log-Rank methods. Cut-off value of tumor diameter for lymph-node metastasis was investigated by Receiver-Operating Characteristics test. Significance between pN0-pN1 and other categorical groups was investigated with Pearson Chi-square or Fisher's exact tests. A total of 257 patients meet to criteria included in the study. Fifty-five (21.4%) of the patients were females. The mean age was 62.7 ± 8.5 and median tumor diameter was 20 mm (Range: 2-30 mm). We detected occult lymph-node metastasis at the N1 stations (pN1) in 33 patients (12.8%) in histopathological examination of resected specimens and lymph-node dissection materials. The cut-off value of tumor diameter was calculated as 21.5 mm for occult lymph-node metastasis by Receiver-Operating Characteristics analysis (Area Under Curved: 70.1%, p = 0.004). There was a significant correlation between pN1 positivity and high tumor diameter (p = 0.02). However, we did not find a correlation between the lymph-node metastasis and age, gender, tumor histopathology, tumor localization, and visceral pleural invasion. Tumor diameter may be an indicator for occult lymph-node metastasis in patients with clinical stage-1A non-small cell lung cancer. This result should be considered in patient with mass which larger than 21.5 mm and planned stereotactic body radiotherapy instead of surgery.
对于临床早期非小细胞肺癌，最佳治疗方案是手术。尽管进行了所有非侵入性和侵入性分期检查，但在病理分期中仍可检测到隐匿性淋巴结转移。在此，我们研究了肿瘤直径与N1站隐匿性淋巴结转移之间是否存在相关性。回顾性分析了临床1A期非小细胞肺癌患者的数据。纳入研究的患者为病理分期肿瘤直径小于3 cm且pN0-pN1的患者。采用Kaplan-Meier法计算总生存期（OS），采用Log-Rank方法研究pN0组和pN1组之间的生存差异。通过受试者工作特征（ROC）检验研究淋巴结转移的肿瘤直径临界值。采用Pearson卡方检验或Fisher精确检验研究pN0-pN1与其他分类组之间的显著性。共有257例患者符合研究纳入标准。其中55例（21.4%）为女性。平均年龄为62.7±8.5岁，肿瘤直径中位数为20 mm（范围：2-30 mm）。在切除标本和淋巴结清扫材料的组织病理学检查中，我们在33例患者（12.8%）的N1站检测到隐匿性淋巴结转移（pN1）。通过ROC分析，隐匿性淋巴结转移的肿瘤直径临界值计算为21.5 mm（曲线下面积：70.1%，p = 0.004）。pN1阳性与高肿瘤直径之间存在显著相关性（p = 0.02）。然而，我们未发现淋巴结转移与年龄、性别、肿瘤组织病理学、肿瘤定位和脏层胸膜侵犯之间存在相关性。肿瘤直径可能是临床1A期非小细胞肺癌患者隐匿性淋巴结转移的一个指标。对于肿瘤直径大于21.5 mm且计划进行立体定向体部放疗而非手术的患者，应考虑这一结果。
