Takizawa T, Terashima M, Koike T, Watanabe T, Kurita Y, Yokoyama A, Honma K
Department of Thoracic Surgery of Niigata Cancer Hospital, Japan.
J Thorac Cardiovasc Surg. 1998 Aug;116(2):276-80. doi: 10.1016/s0022-5223(98)70127-8.
Our aim in this study is to clarify the clinical and pathologic features of small peripheral adenocarcinoma of the lung with special emphasis on intraoperative identification of lymph node metastasis.
Between 1980 and 1996, 157 patients underwent lobectomy and complete hilar/mediastinal lymphadenectomy for small (1.1 to 2.0 cm in diameter) peripheral adenocarcinoma of the lung. The intraoperative assessment, the distribution of metastatic lymph nodes, and the association between the tumor's histopathologic characteristics and lymph node metastasis were retrospectively investigated in this study.
Postoperative examination revealed lymph node metastasis in 27 (17%) patients. Lymph node metastases were not noticed during the operation in 19 of these 27 patients. Metastases were localized in single lymph nodes in 10 patients; the metastases were distributed over a segmental, a lobar, an interlobar, and a mediastinal lymph node. The prevalence of lymph node metastasis was as follows: Of 92 patients with well-differentiated adenocarcinoma, seven (8%) had lymph node metastases; of the 65 patients with other types of tumors, 20 (31%) had lymph node metastases. Of 120 patients without pleural involvement, 13 (11%) had lymph node metastases; of the 37 with pleural involvement, 14 (38%) had lymph node metastases. Five-year survivals were estimated at 91% +/- 6% (mean +/- 95% confidence interval) for 130 patients with N0 tumor and 30% +/- 22% for 27 patients with N1 or N2 tumor.
Intraoperative assessment is not reliable for identifying lymph node metastasis. Lobectomy and complete hilar/ mediastinal lymphadenectomy are necessary to determine N stage rigidly. Histologic degree of differentiation and pleural involvement are significantly associated with lymph node metastasis.
本研究旨在明确肺外周小腺癌的临床和病理特征，特别强调术中对淋巴结转移的识别。
1980年至1996年间，157例患者因肺外周小腺癌（直径1.1至2.0厘米）接受了肺叶切除术及完整的肺门/纵隔淋巴结清扫术。本研究对术中评估、转移淋巴结的分布以及肿瘤组织病理学特征与淋巴结转移之间的关联进行了回顾性调查。
术后检查发现27例（17%）患者有淋巴结转移。这27例患者中有19例在手术过程中未发现淋巴结转移。10例患者的转移局限于单个淋巴结；转移灶分布于段淋巴结、叶淋巴结、叶间淋巴结和纵隔淋巴结。淋巴结转移的发生率如下：92例高分化腺癌患者中，7例（8%）有淋巴结转移；65例其他类型肿瘤患者中，20例（31%）有淋巴结转移。120例无胸膜受累的患者中，13例（11%）有淋巴结转移；37例有胸膜受累的患者中，14例（38%）有淋巴结转移。130例N0期肿瘤患者的5年生存率估计为91%±6%（均值±95%置信区间），27例N1或N2期肿瘤患者的5年生存率为30%±22%。
术中评估对于识别淋巴结转移并不可靠。肺叶切除术及完整的肺门/纵隔淋巴结清扫术对于准确确定N分期是必要的。组织学分化程度和胸膜受累与淋巴结转移显著相关。
