Jin Tianyu, He Zhicheng, Li Zhihua, Tang Jianwei, Xu Jing, Wu Weibing, Chen Liang
Department of Thoracic Surgery, the First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital, Nanjing 210000, China.
Zhongguo Fei Ai Za Zhi. 2023 Jul 20;26(7):507-514. doi: 10.3779/j.issn.1009-3419.2023.102.26.
More early-stage non-small cell lung cancer (NSCLC) are diagnosed in time and treated surgically, but systematic lymph node dissection can not bring enough survival benefits for them, and even increase the probability of postoperative complications. This study aims to analyze the risk factors and evaluate mediastinal lymph node metastasis sites in different lung lobes for NSCLC with diameter ≤2 cm, so as to provide reference for surgery.
We collected 1051 patients with pulmonary nodule diameter ≤2 cm who were treated by pulmonary lobectomy with lymph node sampling/dissection in Department of Thoracic Surgery of the First Affiliated Hospital with Nanjing Medical University from December 2009 to December 2019. SPSS 26.0 statistical software was used for statistical analysis, to explore the risk factors and evaluate mediastinal lymph node metastasis sites in different lung lobes.
95 of 1051 (9.04%) patients presented lymph node metastasis. Male, pathological non-adenocarcinoma, 1 cm<tumor diameter≤2 cm, spread through air spaces (STAS), visceral pleural invasion (VPI), vascular invasion, low differentiation of adenocarcinoma, and micropapillary or solid adenocarcinoma subtype were the risk factors for lymph node metastasis (P<0.01). Male, 1 cm<tumor diameter≤2 cm, STAS, VPI and vascular invasion were independent risk factors for lymph node metastasis (P<0.05). Lymph node metastasis of #2R, #4R, #9 appeared in upper and middle lobe of right lung (P<0.05), and #7 appeared in right lower lobe (P<0.05). Lymph node metastasis of #5 and #6 in the left upper lobe was more common (P<0.05), while metastasis of #7 and #9 had no significant difference (P>0.05). Lymph nodes in group N1 were significantly correlated with lymph node metastasis in groups #2R, #4R, #5, #6, #7 and #9 (P<0.01).
Lobe-specific lymph node dissection (LSND) can be performed for early-stage NSCLC. Male, pathological non-adenocarcinoma, 1 cm<tumor diameter≤2 cm, STAS, VPI, vascular invasion, low differentiation of adenocarcinoma, and micropapillary or solid adenocarcinoma subtype would increase the risk of lymph node metastasis.
越来越多的早期非小细胞肺癌（NSCLC）得以及时诊断并接受手术治疗，但系统性淋巴结清扫并不能为其带来足够的生存获益，甚至还会增加术后并发症的发生概率。本研究旨在分析直径≤2 cm的NSCLC的危险因素，并评估不同肺叶纵隔淋巴结转移部位，为手术提供参考。
收集2009年12月至2019年12月在南京医科大学第一附属医院胸外科接受肺叶切除加淋巴结采样/清扫治疗的肺结节直径≤2 cm的患者1051例。采用SPSS 26.0统计软件进行统计分析，以探究危险因素并评估不同肺叶纵隔淋巴结转移部位。
1051例患者中95例（9.04%）出现淋巴结转移。男性、病理非腺癌、肿瘤直径1 cm＜肿瘤直径≤2 cm、气腔播散（STAS）、脏层胸膜侵犯（VPI）、血管侵犯、腺癌低分化以及微乳头或实性腺癌亚型是淋巴结转移的危险因素（P＜0.01）。男性、肿瘤直径1 cm＜肿瘤直径≤2 cm、STAS、VPI和血管侵犯是淋巴结转移的独立危险因素（P＜0.05）。2R、4R、9组淋巴结转移出现在右肺上叶和中叶（P＜0.05），7组出现在右肺下叶（P＜0.05）。左肺上叶5组和6组淋巴结转移较为常见（P＜0.05），而7组和9组转移无显著差异（P＞0.05）。N1组淋巴结与2R、4R、5、6、7和9组淋巴结转移显著相关（P＜0.01）。
早期NSCLC可进行肺叶特异性淋巴结清扫（LSND）。男性、病理非腺癌、肿瘤直径1 cm＜肿瘤直径≤2 cm、STAS、VPI、血管侵犯、腺癌低分化以及微乳头或实性腺癌亚型会增加淋巴结转移风险。
