cⅠ期周围型NSCLC纵隔淋巴结廓清范围的临床研究

Metastasis of mediastinal lymph nodes in peripheral c-Ⅰ stage non-small cell lung cancer: a clinical study on reasonable dissection of mediastinal lymph nodes

目的:探讨cⅠ期周围型非小细胞肺癌(nonsmall cell lung cancer,NSCLC)纵隔淋巴结合理的廓清范围。方法:回顾性研究196例行系统性纵隔淋巴结廓清的cⅠ期周围型NSCLC患者的临床资料,分析临床病理特征与纵隔淋巴结转移的关系。结果:28例患者术后病理证实为N2,占14.3%(28/196),腺癌、鳞癌患者的纵隔淋巴结转移的发生率分别为18.8%(22/117)、7.6%(6/79),两者相比差异有统计学意义,P=0.023。ⅠA期、ⅠB期患者的发生率分别为7.5%(5/67)、17.8%(23/129),两者相比差异有统计学意义,P=0.049。上叶肿瘤纵隔淋巴结转移80.0%在上纵隔,下叶肿瘤纵隔淋巴结转移76.5%在下纵隔,上、下叶肿瘤均可发生隆突下淋巴结转移。结论:cⅠ期周围型NSCLC应行包括隆突下淋巴结在内的选择性区域纵隔淋巴结廓清。

OBJECTIVE: To investigate the extent of mediastinal lymph nodes dissection in peripheral c-Ⅰ stage non-small cell lung cancer. METHODS: A retrospective study was carried out. Between January,1996 and June, 2003, 196 patients with peripheral c-Ⅰ stage non-small cell lung cancer underwent radical surgery and systemic mediastinal lymph nodes dissection. RESULTS: Among all the 196 patients, p-N2 was found in 28 patients (14.3%). The mediastinal lymph node metastasic rate of adenocarcinoma was 18.8%, and squamous cell carcinoma was 7.6%, P=0.023. The mediastinal lymph node metastasic rate of IA stage was 7.5%, and IB stage was 17.8%, P=0.049. Most of p-N2 disease were regional mediastinal nodal metastasis and surcarinal nodes. CONCLUSION: Regional mediastinal nodal and surcarinal nodal dissection should be routinely performed for clinical Stage Ⅰ peripheral non-small cell lung cancer.