Riquet M, Le Pimpec-Barthes F, Danel C
Service de Chirurgie Thoracique, Hôpital Laënnec, Paris, France.
Ann Thorac Surg. 1998 Sep;66(3):920-2. doi: 10.1016/s0003-4975(98)00556-6.
Axillary lymph node metastases (ALNMs) from bronchogenic carcinoma are rare and their significance may be questioned. A surgical approach may allow a better understanding of the mechanism of their occurrence.
A retrospective study of 1,486 cases of surgically removed non-small cell lung carcinoma was performed. Twenty-two patients (1.5%) had extrathoracic nodal metastases. Nine of them were ALNMs (<1%). These cases form the basis of this study.
In 1 patient ipsilateral ALNM was removed during a lung operation. It was a left non-small cell lung carcinoma invading the chest wall (T3 N2). In the other patients (n = 8) ALNMs were observed during postoperative follow-up; 4 underwent ALNM resection, 2 had radiotherapy, and 2 had symptomatic treatment only. For these 8 patients, in the TNM classification performed after an initial bronchogenic carcinoma operation, the lymph node status was, respectively, N0 in four cases, N1 in three cases, and N2 in one case. Survival ranged from 1 to 10 months, except for one patient who is still alive after more than 5 years. In this case, the ALNM was discovered 4 months after a right lower lobectomy for a T2 N0 adenocarcinoma.
Axillary lymph node metastases may be involved through direct chest wall invasion of bronchogenic carcinoma or retrograde spread from supraclavicular lymphnode block. However, another mechanism seems to be the systemic vascular route.
支气管源性癌的腋窝淋巴结转移（ALNMs）罕见，其意义可能受到质疑。手术方法可能有助于更好地理解其发生机制。
对1486例手术切除的非小细胞肺癌病例进行回顾性研究。22例患者（1.5%）有胸外淋巴结转移。其中9例为ALNMs（<1%）。这些病例构成了本研究的基础。
1例患者在肺手术期间切除了同侧ALNM。这是1例侵犯胸壁的左非小细胞肺癌（T3 N2）。在其他患者（n = 8）中，术后随访期间观察到ALNMs；4例接受了ALNM切除，2例接受了放疗，2例仅接受了对症治疗。对于这8例患者，在初次支气管源性癌手术后进行的TNM分类中，淋巴结状态分别为4例N0、3例N1和1例N2。生存时间为1至10个月，除1例患者在5年多后仍存活。在该病例中，ALNM在右下叶切除术后4个月被发现，该患者为T2 N0腺癌。
腋窝淋巴结转移可能通过支气管源性癌直接侵犯胸壁或锁骨上淋巴结阻塞逆行扩散所致。然而，另一种机制似乎是全身血管途径。
