ⅢA期非小细胞肺癌N2淋巴结跳跃转移的临床分析

Clinical analysis of skip N2 metastases in stage ⅢA non-small cell lung cancer

背景与目的:在ⅢA期非小细胞肺癌(non-small cell lung cancer,NSCLC)中,N2淋巴结跳跃转移的特点还不十分清楚,N2跳跃转移者和非跳跃转移者的生存率是否存在差异仍有争议。本研究探讨N2跳跃转移的临床病理特征和分布规律,并分析跳跃转移与生存率的关系。方法:收集南通大学附属医院292例行肺肿瘤切除加系统性胸内淋巴结廓清术的ⅢA期NSCLC患者临床资料,分为跳跃转移组和非跳跃转移组,回顾性分析两组病例的临床病理特征、跳跃转移N2分布方式及其生存率情况,并进行统计学分析。结果:(1)在ⅢA期NSCLC中,N2跳跃转移的发生率为15.8%,与肿瘤大小有关(P<0.05)。(2)跳跃转移时,肿瘤部位与阳性N2淋巴结组的关系:右上肺叶,85.7%N2位于3、4组;右中肺叶,75.0%N2位于第7组;右下肺叶,81.0%N2位于3、7组;左上肺叶,80.0%N2位于5、6组;左下肺叶,65.0%N2位于第7组。(3)跳跃转移组3年生存率为45.4%,非跳跃转移组为29.5%。生存分析显示,除N2淋巴结跳跃转移外,肿瘤的大小、病理类型、手术方式、辅助化、放疗都是影响ⅢA期NSCLC预后的独立危险因素。结论:在ⅢA期NSCLC中,不同肺叶肿瘤有相应的好发跳跃转移的N2淋巴结组;N2跳跃转移是NSCLC的独立预后因素,跳跃转移者具有更高的生存率。

Background and Objective： Clinical characteristics of skip N2 metastasis of stage Ⅲ A non-small cell lung cancer （NSCLC） are not clear. This study was to investigate the clinicopathologic features and the distribution pattern of N2 lymph nodes, thus to analyze the relationship between the survival rate and skip metastasis of NSCLC patients. Methods： Clinical data of 292 patients with stage Ⅲ A NSCLC undergoing radical surgical resection plus mediastinal nodal dissection in the Affiliated Hospital of Nantong University were retrospectively reviewed. Clinicopathologic features, distribution of skip N2 metastasis and survival were analyzed respectively. Results： The incidence rate of skip N2 metastasis in stage Ⅲ A NSCLC patients was 15.8%, which was correlated to the size of the tumor （P〈0.05）. Moreover, the relationship between the primary tumor location and N2 positive lymph nodes were described as follows：right upper lobe cancer displayed skip-N2 nodal metastasis mostly in the 3rd and 4th station （85.7%）, right middle lobe mostly in the 7th station （75.0%）, right lower lobe mostly in the 3rd and 7th station（81.0%）, left upper lobe mostly in the 5th and 6th station （80.0%）, and left lower lobe mostly in the 7th station （65.0%）. The 3-year survival rate of patients with skip N2 metastasis was 45,4%, compared to 29,5% in patients with the involvement of N1 and N2 nodes. Survival analysis showed that skip N2 metastasis was an independent risk factor of stage Ⅲ A NSCLC in addition to tumor size, histology, type of resection, adjuvant chemotherapy and radiotherapy. Conclusions： In stage Ⅲ A NSCLC, primary tumors in different locations have their own corresponding areas of N2 nodal metastasis. Skip N2 metastasis is an independent prognostic factor for the survival of NSCLC. Patients with skip N2 metastasis have a favorable outcome.