Daly B D, Mueller J D, Faling L J, Diehl J T, Bankoff M S, Karp D D, Rand W M
Department of Cardiothoracic Surgery, Tufts University School of Medicine, Boston, Mass.
J Thorac Cardiovasc Surg. 1993 May;105(5):904-10; discussion 910-1.
Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan-Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.
在过去13年中，681例连续患者接受了纵隔的计算机断层扫描分期和手术分期。501例患者经计算机断层扫描分期显示纵隔淋巴结肿大为阴性，其中37例患者在开胸手术（n = 36）或纵隔镜检查（n = 1）时发现纵隔淋巴结癌转移。根据肿瘤的T分期、肿瘤的中央或外周位置、细胞类型、纵隔受累区域以及肿瘤的淋巴结受累程度，对这组患者的生存情况进行了分析。12例患者为中央型肿瘤，25例为外周型肿瘤。中央型肿瘤组中有2例患者术后死亡，仅2例存活，而外周型肿瘤组的25例患者中有12例存活。37例患者中有4例（每组2例）未接受手术切除，均死亡。31例接受手术切除的幸存者中，除2例之外，其余均接受了术后辅助放疗（23例患者）、化疗（1例患者）或放疗及化疗（5例患者）。总体患者的预计2年和5年生存率（Kaplan-Meier法）分别为40%和28%，肿瘤切除患者分别为46%和31%，中央型肿瘤切除患者分别为40%和20%，外周型肿瘤切除患者分别为52%和45%。这些差异均无统计学意义。细胞类型、受累淋巴结的位置或数量，以及纵隔淋巴结受累的平均百分比或最大百分比均不影响生存。纵隔淋巴结计算机断层扫描分期的高阴性预测指数，以及胸部计算机断层扫描假阴性患者的观察到的2年和5年生存率，证明对于大多数计算机断层扫描显示纵隔正常的患者，无需进行纵隔镜检查即可直接进行开胸手术。
