Liu J W, Zhang X N, Lin G, Li J
Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China.
Zhonghua Wai Ke Za Zhi. 2023 Dec 1;61(12):1086-1092. doi: 10.3760/cma.j.cn112139-20230217-00065.
To examine whether the highest mediastinal lymph node (HMLN) metastasis had an influence on postoperative recurrence and survival among non-small cell lung cancer (NSCLC) patients with pN2 lymph node metastasis. A total of 261 patients who underwent radical resection of lung cancer and systematic lymph node dissection in the Department of Thoracic Surgery of Peking University First Hospital from January 2007 to December 2016 were retrospectively analyzed. There were 180 males and 81 females, aged (61.5±9.4) years (range: 31 to 83 years). There were 128 cases of HMLN-positive and 133 cases of HMLN-negative. They were pathologically confirmed N2 stage NSCLC and postoperative recurrence and survival were followed up. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS) curves according to whether HMLN metastasize or not. The Cox proportional hazards regression model was used for the prognostic analysis. The median DFS and the median OS of the whole group were 28 months and 44 months, respectively. The median DFS in HMLN-positive and HMLN-negative patients was 19 months and 33 months, respectively (=0.005). The median OS of HMLN-positive and HMLN-negative group was 37 months and 49 months, respectively (=0.005). Multivariate analysis showed that pneumonectomy and visceral pleural invasion were independent risk factors for both postoperative OS (=1.85, 95%: 1.25 to 2.72, =0.002; =1.82, 95%: 1.30 to 2.56, =0.007) and DFS (=1.61, 95%: 1.10 to 2.35, =0.014; =1.77, 95%: 1.27 to 2.46,=0.001). HMLN metastasis and lymphovascular invasion were independent risk factors for only postoperative DFS (=1.39, 95%: 1.03 to 1.87, =0.030; =1.40, 95%: 0.99 to 1.81, =0.042). For patients of pN2 stage NSCLC, both postoperative recurrence and long-term survival were significantly worse in the HMLN metastatic group. In addition, pneumonectomy and visceral pleural invasion were unfavorable factors that affected both recurrence and overall survival. HMLN metastasis and lymphovascular invasion could shorten the postoperative time for DFS.
探讨最高纵隔淋巴结（HMLN）转移对pN2淋巴结转移的非小细胞肺癌（NSCLC）患者术后复发及生存的影响。回顾性分析2007年1月至2016年12月在北京大学第一医院胸外科接受肺癌根治性切除术及系统性淋巴结清扫术的261例患者。其中男性180例，女性81例，年龄（61.5±9.4）岁（范围：31至83岁）。HMLN阳性128例，HMLN阴性133例。均经病理确诊为N2期NSCLC，术后对复发及生存情况进行随访。采用Kaplan-Meier法根据HMLN是否转移计算无病生存期（DFS）和总生存期（OS）曲线。采用Cox比例风险回归模型进行预后分析。全组患者的中位DFS和中位OS分别为28个月和44个月。HMLN阳性和HMLN阴性患者的中位DFS分别为19个月和33个月（=0.005）。HMLN阳性和HMLN阴性组的中位OS分别为37个月和49个月（=0.005）。多因素分析显示，肺叶切除术和脏层胸膜侵犯是影响术后OS（=1.85，95%置信区间：1.25至2.72，=0.002；=1.82，95%置信区间：1.30至2.56，=0.007）和DFS（=1.61，95%置信区间：1.10至2.35，=0.014；=1.77，95%置信区间：1.27至2.46，=0.001）的独立危险因素。HMLN转移和淋巴管侵犯仅是影响术后DFS的独立危险因素（=1.39，95%置信区间：1.03至1.87，=0.030；=1.40，95%置信区间：0.99至1.81，=0.042）。对于pN2期NSCLC患者，HMLN转移组的术后复发及长期生存均明显较差。此外，肺叶切除术和脏层胸膜侵犯是影响复发及总生存的不利因素。HMLN转移和淋巴管侵犯可缩短术后DFS时间。
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