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原发性肺癌切除术后纵隔淋巴结跳跃转移对预后的影响。

Impact of skip mediastinal lymph node metastasis on outcomes after resection for primary lung cancer.

机构信息

Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.

Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.

出版信息

Lung Cancer. 2023 Oct;184:107341. doi: 10.1016/j.lungcan.2023.107341. Epub 2023 Aug 9.


DOI:10.1016/j.lungcan.2023.107341
PMID:37573704
Abstract

OBJECTIVES: Patients with non-small cell lung cancer and nodal disease are a heterogeneous group with varied patterns of disease. The aim of this study was to assess long-term outcomes of patients with skip N2 disease in comparison to those with N1 or non-skip N2 disease. MATERIALS AND METHODS: A retrospective review of 445 patients undergoing anatomical lung resection for primary lung cancer between 2012 and 2019 with post-operative histological confirmation of nodal disease was undertaken. Log rank analysis was used to assess differences in estimated median overall survival according to nodal status. Multivariable Cox regression analysis was performed to determine whether skip N2 disease was independently associated with overall survival. RESULTS: Mean patient age was 67.0 years (standard deviation ± 9.2 years) and 48.1% (n = 214) were male. In total, 20.7% (n = 92) of patients had N1 disease, 32.1% (n = 143) had skip N2 disease and 47.2% (n = 210) had non-skip N2 disease. Post-operative upstaging took place in 33.0% (n = 147) of patients. Median follow-up time was 35 months (interquartile range 14-68 months). Skip N2 patients had significantly longer estimated median overall survival in comparison to their non-skip N2 counterparts (47 months vs 28 months, log rank analysis p = 0.029) and non-skip N2 disease remained independently associated with reduced overall survival after multivariable analysis (hazard ratio 1.421, 95% confidence interval 1.060-1.907, p = 0.019). CONCLUSION: Skip N2 disease is a positive prognostic factor for patients with N2 lung cancer, suggesting that lung cancer staging guidelines should consider separating N2 disease into additional subgroups in order to improve prognostic accuracy.

摘要

目的:患有非小细胞肺癌和淋巴结疾病的患者是一组具有不同疾病模式的异质群体。本研究旨在评估跳跃 N2 疾病患者与 N1 或非跳跃 N2 疾病患者的长期预后。

材料和方法:对 2012 年至 2019 年间接受解剖性肺切除术治疗原发性肺癌且术后组织学证实淋巴结疾病的 445 例患者进行回顾性分析。采用对数秩分析评估根据淋巴结状况估计的中位总生存期的差异。进行多变量 Cox 回归分析以确定跳跃 N2 疾病是否与总生存期独立相关。

结果:患者的平均年龄为 67.0 岁(标准差±9.2 岁),48.1%(n=214)为男性。共有 20.7%(n=92)的患者患有 N1 疾病,32.1%(n=143)患有跳跃 N2 疾病,47.2%(n=210)患有非跳跃 N2 疾病。33.0%(n=147)的患者术后分期升级。中位随访时间为 35 个月(四分位距 14-68 个月)。与非跳跃 N2 患者相比,跳跃 N2 患者的中位估计总生存期明显更长(47 个月 vs 28 个月,对数秩分析 p=0.029),并且在多变量分析后,非跳跃 N2 疾病仍然与总生存期缩短独立相关(风险比 1.421,95%置信区间 1.060-1.907,p=0.019)。

结论:跳跃 N2 疾病是 N2 肺癌患者的一个阳性预后因素,这表明肺癌分期指南应考虑将 N2 疾病进一步分为亚组,以提高预后准确性。

相似文献

[1]
Impact of skip mediastinal lymph node metastasis on outcomes after resection for primary lung cancer.

Lung Cancer. 2023-10

[2]
Survival benefit of skip metastases in surgically resected N2 non-small cell lung cancer: A multicenter observational study of a large cohort of the Chinese patients.

Eur J Surg Oncol. 2020-10

[3]
[Clinical analysis of skip N2 metastases in stage IIIA non-small cell lung cancer].

Ai Zheng. 2009-7

[4]
Analysis of risk factors for skip lymphatic metastasis and their prognostic value in operated N2 non-small-cell lung carcinoma.

Eur J Surg Oncol. 2006-6

[5]
Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors.

J Thorac Cardiovasc Surg. 2005-4

[6]
Role of Skip Mediastinal Lymph Node Metastasis for Patients With Resectable Non-small-cell Lung Cancer: A Propensity Score Matching Analysis.

Clin Lung Cancer. 2018-12-19

[7]
Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancer.

J Surg Oncol. 2003-4

[8]
Skip mediastinal nodal metastases in non-small cell lung cancer.

Eur J Cardiothorac Surg. 2004-6

[9]
Single-station skip-N2 disease: good prognosis in resected non-small-cell lung cancer (long-term results in skip-N2 disease).

Interact Cardiovasc Thorac Surg. 2019-2-1

[10]
Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer.

Interact Cardiovasc Thorac Surg. 2011-5

引用本文的文献

[1]
Prognostic impacts of skip metastasis in N2a and N2b subgroups of non-small cell lung cancer: insights from a large cohort.

Transl Lung Cancer Res. 2025-7-31

[2]
Validation for revision of the stage IIIA(T1N2) in the forthcoming ninth edition of the TNM classification for lung cancer.

BMC Cancer. 2025-3-12

[3]
DFA-UNet: dual-stream feature-fusion attention U-Net for lymph node segmentation in lung cancer diagnosis.

Front Neurosci. 2024-7-15

[4]
A survival nomogram model for patients with resectable non-small cell lung cancer and lymph node metastasis (N1 or N2) based on the Surveillance, Epidemiology, and End Results Database and single-center data.

Transl Lung Cancer Res. 2024-3-29

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