Department of Thoracic Surgery, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Radiology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Thorac Cancer. 2023 Oct;14(30):2993-3000. doi: 10.1111/1759-7714.15088. Epub 2023 Sep 4.
In this study, the focus was primarily on examining the occurrence of lymph node metastasis in T1 lung adenocarcinoma, while also analyzing the relationship between clinical variables such as imaging characteristics, pathological classifications, and lymph node metastasis.
We retrospectively analyzed data from patients with T1 lung adenocarcinoma who underwent lobectomy and lymph node dissection between January 2016 and December 2019. Utilizing univariate and multivariate analyses, we assessed the associations between lymph node metastasis and various clinical factors, including imaging characteristics, lesion location and depth, and pathological subtypes.
Of the 433 patients with T1 lung adenocarcinoma, 139 had lymph node metastasis. Moreover, the incidence of node 1 (N1) lymph node, sequential, and node 2 (N2) skip metastases were 12.2%, 12.7%, and 7.2%, respectively. Univariate analysis revealed that tumor diameter, depth ratio, sex, invasive imaging features, and pathological subtype were significantly associated with lymph node metastasis. Multivariate analysis revealed that the tumor depth ratio, tumor diameter, pleural indentation or traction sign, nonvascular penetration sign, solid component, nonadherence, and micropapillary pathological subtype were risk factors for lymph node metastasis. In the multivariate analysis, the micropapillary pathological subtype was an independent risk factor for N2 skip metastasis.
In patients with clinical stage T1 lung adenocarcinoma, the risk of lymph node metastasis is higher for tumors located deep within the lung tissue with solid components, invasive preoperative imaging features, and larger diameters. For N2 skip lymph node metastasis, the micropapillary pathological subtype represents a significant high-risk factor.
本研究主要关注 T1 期肺腺癌的淋巴结转移情况，并分析影像学特征、病理分类和淋巴结转移等临床变量之间的关系。
我们回顾性分析了 2016 年 1 月至 2019 年 12 月期间接受肺叶切除术和淋巴结清扫术的 T1 期肺腺癌患者的数据。利用单因素和多因素分析，评估了淋巴结转移与各种临床因素（包括影像学特征、病变位置和深度以及病理亚型）之间的关系。
在 433 例 T1 期肺腺癌患者中，有 139 例发生淋巴结转移。此外，N1 淋巴结、顺序和 N2 跳跃转移的发生率分别为 12.2%、12.7%和 7.2%。单因素分析显示，肿瘤直径、深度比、性别、侵袭性影像学特征和病理亚型与淋巴结转移显著相关。多因素分析显示，肿瘤深度比、肿瘤直径、胸膜凹陷或牵引征、非血管穿透征、实性成分、非贴壁和微乳头病理亚型是淋巴结转移的危险因素。在多因素分析中，微乳头病理亚型是 N2 跳跃转移的独立危险因素。
在临床分期为 T1 期的肺腺癌患者中，位于肺组织深部、具有实性成分、具有侵袭性术前影像学特征和较大直径的肿瘤发生淋巴结转移的风险较高。对于 N2 跳跃淋巴结转移，微乳头病理亚型是一个显著的高危因素。
