Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Ann Surg Oncol. 2024 Aug;31(8):5028-5037. doi: 10.1245/s10434-024-15184-1. Epub 2024 Mar 23.
Highest mediastinal lymph node (HMLN) involvement is a category of uncertain resection, yet the prognostic significance of HMLN involvement remains controversial.
A total of 486 patients with pathological stage III-N2 disease who underwent radical resection were enrolled from January 2015 to December 2018. Patients were allocated into two groups-HMLN involvement (219 cases) and HMLN-negative (249 cases) groups. Kaplan-Meier analysis and Cox proportional hazard regression models were used to evaluate the impact of HMLN involvement on 5-year recurrence-free survival (RFS) and overall survival (OS).
The proportion of patients with multiple N2 diseases (72.1% vs. 23.7%; p < 0.001) and stage IIIA (87.2% vs. 77.5%; p < 0.009) were greater in the HMLN-involvement group than in the HMLN-negative group, and the survival rates of the HMLN-involvement group were significantly lower than those of the HMLN-negative group (RFS: 27.2% vs. 49.8%, p < 0.001; OS: 42.1% vs. 59.2%, p = 0.001). HMLN status was an independent factor for OS only (RFS: adjusted hazard ratio [aHR] 1.26, 95% confidence interval CI 0.94-1.68; OS: aHR 1.45, 95% CI 1.07-1.99) in the entire stage III cohort. After stratification of patients according to stage, the involvement of HMLN decreased both RFS and OS in the stage IIIA group (RFS: aHR 1.46, 95% CI 1.06-2.02; OS: aHR 1.70, 95% CI 1.19-2.42); however, no such difference was observed within the stage IIIB group.
HMLN involvement is a prognostic factor of deteriorating survival in highly advanced N2 disease only in patients with stage IIIA.
最高纵隔淋巴结（HMLN）受累属于不确定切除范畴，但 HMLN 受累的预后意义仍存在争议。
共纳入 2015 年 1 月至 2018 年 12 月期间行根治性切除术的 486 例病理分期为 III-N2 期的患者。将患者分为 HMLN 受累（219 例）和 HMLN 阴性（249 例）两组。采用 Kaplan-Meier 分析和 Cox 比例风险回归模型评估 HMLN 受累对 5 年无复发生存（RFS）和总生存（OS）的影响。
HMLN 受累组的患者中，存在多处 N2 疾病（72.1% vs. 23.7%；p<0.001）和 IIIA 期疾病（87.2% vs. 77.5%；p<0.009）的比例高于 HMLN 阴性组，HMLN 受累组的生存率明显低于 HMLN 阴性组（RFS：27.2% vs. 49.8%，p<0.001；OS：42.1% vs. 59.2%，p=0.001）。HMLN 状态仅为整个 III 期队列 OS 的独立因素（RFS：调整后的风险比[aHR]1.26，95%置信区间[CI]0.94-1.68；OS：aHR 1.45，95%CI 1.07-1.99）。在根据分期对患者进行分层后，HMLN 受累降低了 IIIA 期患者的 RFS 和 OS（RFS：aHR 1.46，95%CI 1.06-2.02；OS：aHR 1.70，95%CI 1.19-2.42）；然而，在 IIIB 期患者中并未观察到这种差异。
仅在 IIIA 期患者中，HMLN 受累是高度进展性 N2 疾病生存恶化的预后因素。
