314例非小细胞肺癌胸内淋巴结转移规律的临床意义

Clinical significance of patterns of intrathoracic lymph node metastasis in non-small cell lung cancer：an analysis of 314 patients

目的 探索NSCLC胸内淋巴结的转移规律,为放疗靶区勾画提供理论依据.方法 回顾分析314例NSCLC术后患者的临床资料,重点探讨胸内淋巴结的分布特点、转移范围,及其与肿瘤大小、病理类型及原发部位的关系.x2检验组间差别.结果 NSCLC术后4、5、7、10、11组淋巴结转移率均＞12％,1、2、3、6、8、9组均＜12％.原发肿瘤部位与N2组淋巴结转移相近（P=0.102）.而原发灶T3、T4期出现N2组淋巴结转移概率较T1、T2期明显增高（17.0％∶11.6％,P=0.002）,腺癌较鳞癌N2组更易转移（34.5％∶23.2％,P=0.008）.结论 T3、T4期NSCLC及腺癌患者术后放疗靶区勾画时应着重关注第4、5、7、10、11组淋巴结.

Objective To investigate the patterns of intrathoracic lymph node metastasis in nonsmall cell lung cancer （NSCLC） and to provide a theoretical basis for the delineation of radiotherapy target volume.Methods A retrospective analysis was performed on the clinical data of 314 NSCLC patients after operation.Our focus was to investigate the distribution characteristics and metastatic extent of intrathoracic lymph nodes and their relationship with tumor size,pathological type,and primary site.Comparisons between groups were made by one-way analysis of variance.Results The frequencies of metastases to lymph nodes at stations 4,5,7,10,and 11 were all above 12％,while those at stations 1,2,3,6,8,and 9 were all below 12％.The lymph node metastasis rate was similar on the primary tumor site （P =0.102）.The patients with T3 and T4 NSCLC had a significantly higher frequency of N2 lymph node metastasis than those with T1 and T2 NSCLC （17.0％ vs.11.6％,P =0.002） ;the patients with adenocarcinoma had a significantly higher frequency of N2 lymph node metastasis than those with squamous cell carcinoma （34.5 ％ vs.23.2％,P =0.008）.Conclusions For patients with T3 and T4 NSCLC of adenocarcinoma subtype,we should highlight the lymph nodes at stations 4,5,7,10,and 11 when delineating the radiotherapy target volume after operation.