区域淋巴结微小转移对非小细胞肺癌长期生存的影响

The Influence of Micrometastases of Regiondal Lymph Nodes on the Survival of Patients with Non-Small Cell Lung Cancer

目的:检测非小细胞肺癌(NSCLC)根治术后常规病理诊断无转移的区域淋巴结中的微小转移,研究微小转移对预后的影响。方法:收集根治术后常规病理证实为T1-4N0-1M0的107例NSCLC的肺门及纵隔淋巴结蜡块,采用Envision二步法检测。结果:NSCLC中微小转移检出率为29.9%。非微小转移病例的1、3、5年生存率及中位生存期较微小转移病例明显延长(均P<0.05)。Cox回归显示KPS评分、CK、T分期及病理分级是影响生存期的独立因素(均P<0.05)。术后放化疗与单纯手术比较术后放化疗组长期生存有优势,但无统计学意义(P>0.05)。结论:NSCLC淋巴结微小转移是影响长期生存的不利因素,放化疗干预有可能延长生存。

Objective： To detect the micrometastases in lymph nodes at pathologically affirmed nonmetastasis area of non-small-cell lung cancer （NSCLC） after radical correction, and to study its influ- ence on the prognosis of the disease. Methods： Paraffin-embedded specimens of hilum and mediastinal lymph node of T1-4N0-1 M0 in 107 cases of pathologically affirmed NSCLC patients were collected, and the micrometastasis in them was detected with EnVision method. Results： The total positive rate of mi- crometastasis in patients was 29.9%. The 1-, 3-, and 5-year survival rates and median survival time of non-micrometastasis group were significantly higher than those of micrometastasis group （ P 〈 0. 05 ）. Cox regression prognostic analysis showed that KPS scores, and pathological grade CK, and T were independent predictors of overall survival（P 〈 0.05）. Postoperative radiochemotherapy showed more advantage than surgery only, but no statistical significance was found（P 〉0.05）. Condusions： Micrometastasis is a disadvantageous factor to survival of patients with NSCLC, and intervention of radiotherapy and chemotherapy could extend patient＇s life.