Kurose Yasuko, Azuma Yoko, Iyoda Akira, Tochigi Naobumi
Department of Surgical Pathology, Faculty of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
Department of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan.
J Thorac Dis. 2024 Sep 30;16(9):5878-5889. doi: 10.21037/jtd-24-792. Epub 2024 Sep 21.
The N parameter in the tumor-node-metastasis (TNM) classification of lung cancer is categorized according to the location of nodal metastasis, while that for some other cancers are classified according to the size and number of metastatic foci. In lung cancer, the impact of size of nodal metastasis on prognosis is unclear. This analysis aims to examine whether it is possible to subdivide the pathological N (pN) factor based on the tumor diameter of lymph node metastases.
We studied 35 cases of adenocarcinoma and 26 cases of squamous cell carcinoma of the lung. The maximum diameter of lymph node metastasis was measured, and the relationship between the maximum diameter of lymph node metastases and prognosis was investigated.
Squamous cell carcinoma cases had a significantly larger maximum tumor diameter of lymph node metastasis than adenocarcinoma cases (P=0.03). Based on receiver operating characteristic (ROC) curve results for the adenocarcinoma cases, we set 4 mm as a diameter cutoff value. The 5-year overall survival (OS) rate was 85.6% for patients with diameters ≤4 mm and 57.7% for those with diameters >4 mm; this difference was statistically significant (P=0.04). On univariate analysis using a Cox proportional hazards model, significant differences were observed in metastatic lymph node diameter (≤4 >4 mm) (P=0.04), sex (P=0.04), and pathological T (pT) status (pT1 and 2 pT3 and 4) (P=0.03). However, similar results were not obtained for patients with squamous cell carcinoma.
The tumor diameter of pathological N1 lymph node metastases impacts the prognosis of patients with lung adenocarcinoma. If pathological N1 can be further subdivided according to tumor diameter of lymph node metastases, a more accurate prognosis may become possible. However, pathological type must be considered for staging in lung cancer. While the pN parameter for most cancers considers tumor size of lymph node metastasis, this does not apply to lung cancer.
肺癌的肿瘤-淋巴结-转移（TNM）分类中的N参数是根据淋巴结转移的位置进行分类的，而其他一些癌症的N参数是根据转移灶的大小和数量进行分类的。在肺癌中，淋巴结转移大小对预后的影响尚不清楚。本分析旨在研究是否有可能根据淋巴结转移灶的肿瘤直径对病理N（pN）因子进行细分。
我们研究了35例肺腺癌和26例肺鳞状细胞癌。测量淋巴结转移的最大直径，并研究淋巴结转移最大直径与预后之间的关系。
肺鳞状细胞癌病例的淋巴结转移最大肿瘤直径显著大于肺腺癌病例（P = 0.03）。根据腺癌病例的受试者工作特征（ROC）曲线结果，我们将4 mm设定为直径临界值。直径≤4 mm的患者5年总生存率（OS）为85.6%，直径>4 mm的患者为57.7%；这种差异具有统计学意义（P = 0.04）。使用Cox比例风险模型进行单因素分析时，在转移淋巴结直径（≤4与>4 mm）（P = 0.04）、性别（P = 0.04）和病理T（pT）状态（pT1和2与pT3和4）（P = 0.03）方面观察到显著差异。然而，肺鳞状细胞癌患者未获得类似结果。
病理N1淋巴结转移灶的肿瘤直径影响肺腺癌患者的预后。如果可以根据淋巴结转移灶的肿瘤直径对病理N1进行进一步细分，则可能实现更准确的预后评估。然而，在肺癌分期时必须考虑病理类型。虽然大多数癌症的pN参数考虑淋巴结转移的肿瘤大小，但这不适用于肺癌。
