Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China.
Department of Thoracic Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, China.
Respir Res. 2024 Feb 21;25(1):96. doi: 10.1186/s12931-024-02727-z.
Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell lung cancer (NSCLC).
Patients with cT1 NSCLC who underwent anatomical resection between 2010 and 2019 were retrospectively screened. Univariable and multivariable logistic regression analyses were adopted to evaluate the associations between nodule radiological appearance and lymph node metastasis. The log-rank test and Cox regression analyses were applied for prognostic evaluation. The cumulative recurrence risk was evaluated by the competing risk model.
There were 958 and 665 NSCLC patients with PSN and SN. Compared to the PSN group, the SN arm had a higher overall lymph node metastasis rate (21.7% vs. 2.7%, P < 0.001), including nodal metastasis at N1 stations (17.7% vs. 2.1%), N2 stations (14.0% vs. 1.6%), and skip nodal metastasis (3.9% vs. 0.6%). However, for cT1a NSCLC, no significant difference existed between SN and PSN (0 vs. 0.4%, P = 1). In addition, the impacts of nodule radiological appearance on lymph node metastasis varied between nodal stations. Solid NSCLC had an inferior prognosis than part-solid patients (5-year disease-free survival: 79.3% vs. 96.2%, P < 0.001). The survival inferiority only existed for cT1b and cT1c NSCLC, but not for cT1a. Strikingly, even for patients with nodal involvement, SN still had a poorer disease-free survival (P = 0.048) and a higher cumulative incidence of recurrence (P < 0.001) than PSN. Specifically, SN had a higher recurrence risk than PSN at each site. Nevertheless, the distribution of recurrences between SN and PSN was similar, except that N2 lymph node recurrences were more frequent in solid NSCLC (28.21% vs. 7.69%, P = 0.041).
SN had higher risks of lymph node metastasis and poorer prognosis than PSN for cT1b and cT1c NSCLC, but not for cT1a. SN exhibited a greater proportion of N2 lymph node recurrence than PSN. SN and PSN needed distinct strategies for nodal evaluation and postoperative follow-up.
实性结节（SN）比部分实性结节（PSN）具有更具侵袭性的特征和更差的预后。本研究旨在评估基于 cT1 非小细胞肺癌（NSCLC）中实性大小，结节影像学表现（SN 与 PSN）对淋巴结转移和预后的具体影响。
回顾性筛选了 2010 年至 2019 年接受解剖切除术的 cT1 NSCLC 患者。采用单变量和多变量逻辑回归分析评估结节影像学表现与淋巴结转移之间的关联。采用对数秩检验和 Cox 回归分析进行预后评估。采用竞争风险模型评估累积复发风险。
共有 958 例和 665 例 PSN 和 SN NSCLC 患者。与 PSN 组相比，SN 组的总体淋巴结转移率更高（21.7% vs. 2.7%，P<0.001），包括 N1 站（17.7% vs. 2.1%）、N2 站（14.0% vs. 1.6%）和跳跃性淋巴结转移（3.9% vs. 0.6%）。然而，对于 cT1a NSCLC，SN 与 PSN 之间无显著差异（0 与 0.4%，P=1）。此外，结节影像学表现对淋巴结转移的影响在不同淋巴结部位之间存在差异。实性 NSCLC 的无病生存率低于部分实性患者（5 年无病生存率：79.3% vs. 96.2%，P<0.001）。这种生存劣势仅存在于 cT1b 和 cT1c NSCLC，而不存在于 cT1a。值得注意的是，即使对于存在淋巴结受累的患者，SN 仍具有较差的无病生存率（P=0.048）和更高的累积复发率（P<0.001）。具体而言，与 PSN 相比，SN 在每个部位的复发风险更高。然而，SN 和 PSN 之间的复发分布相似，除了 N2 淋巴结复发在实性 NSCLC 中更为常见（28.21% vs. 7.69%，P=0.041）。
对于 cT1b 和 cT1c NSCLC，SN 的淋巴结转移风险和预后均高于 PSN，但对于 cT1a 则不然。与 PSN 相比，SN 具有更高比例的 N2 淋巴结复发。对于淋巴结评估和术后随访，SN 和 PSN 需要采用不同的策略。
Zotero 插件
