T1期外周型肺癌临床病理特征及淋巴结转移分析

Analysis of pathological characteristics and lymphatic metastasis in stage T1 peripheral lung cancer

目的探讨T1期外周型肺癌的临床病理特征、淋巴结转移情况及二者相关性,并进一步评估肺段切除术的适应证。方法 133例临床T1期外周型肺癌标本根据2015版WHO肺癌分类对其进行分类,并进行统计分析。结果腺癌103例,鳞癌16例,腺鳞癌4例,其他类型10例。手术共清扫胸内淋巴结1022枚,有155枚淋巴结存在癌转移,转移率15.2%,有淋巴结转移的患者占26.3%(35/133)。肿瘤直径≤1 cm患者淋巴结转移率5.3%,明显低于其他两种直径的24.1%、35.7%(P<0.05)。肿瘤为实性者共76例,转移率46.1%,明显高于磨玻璃样组的0(P<0.05)。结论 T1期肺癌患者也会发生淋巴结转移,对于肿瘤直径>2 cm者,淋巴结清扫是必要的。对于肿瘤直径≤1 cm,及CT提示病灶磨玻璃结节的患者,可不做淋巴结清扫,可行淋巴结取样。

Objective To investigate pathological characteristics and lymphatic metastasis in stage T1 peripheral lung cancer, and their correlation, so as to further evaluate indication of pulmonary segmentectomy. Methods A total of 133 samples with stage T1 peripheral lung cancer were classified and statistically analyzed by 2015 WHO lung cancer classification. Results There were 103 adenocarcinoma cases, 16 squamous carcinoma cases, 4 adenosquamous carcinoma cases and 10 cases with other types. A total of 1022 intrathoracic lymph nodes were cleaned in operation, and 155 cases with cancerometastasis, with metastasis rate as 15.2%. Patients with lymphatic metastasis accounted for 26.3%（35/133）. Patients with tumor diameter ≤ 1 cm had much lower lymphatic metastasis rate as 5.3% than 24.1% and 35.7% in the other two diameters（P〈0.05）. Metastasis rate in 76 solid tumor cases was obviously higher as 46.1% than 0 in ground glass cases（P〈0.05）. Conclusion Due to occurrence of lymphatic metastasis in patients with stage T1 lung cancer, it is necessary for patients with tumor diameter 〉2 cm to take lymph node dissection. Patients with tumor diameter ≤ 1 cm and ground glass node shown by CT can receive lymph node sampling instead of dissection.