摘要
目的探讨N2淋巴结转移状态对pN2/Ⅲ期非小细胞肺癌(NSCLC)预后的影响。方法接受手术治疗的pN2/Ⅲ期NSCLC患者206例,分析N2淋巴结转移状态并计算其纵隔淋巴结转移率(MLNR),通过Kaplan-Meier法和Cox比例风险模型分析纵隔淋巴结转移状态与NSCLC患者术后总生存时间(OS)的关系。结果206例pN2/Ⅲ期NSCLC患者中位生存时间29.6个月;Kaplan—Meier分析显示,多站N2淋巴结转移、N2淋巴结转移数〉2枚、N2跳跃性转移、隆突下淋巴结转移阳性以及高纵隔淋巴结转移率(MLNR,≥33%)的患者生存时间明显缩短(P〈0.05)。Cox比例风险模型分析显示,隆突下淋巴结转移阳性(HR=1.81,95%CI1.18,2.79,P〈0.01),MLNR≥33%(HR=1.54,95%CI1.02,2.33,P〈0.05)是影响NSCLC患者预后的独立危险因素。结论纵隔淋巴结跳跃性转移、隆突下淋巴结转移、纵隔淋巴结转移站数和转移数目以及MLNR与pN2/Ⅲ期NSCLC患者术后0S显著相关,可能是影响pN2/Ⅲ期NSCLC患者预后的危险因素。
Objective To evaluate the metastasis status of 512 lymph node and their impacts to long-time survival in non-small cell lung cancer(NSCLC) patients. Methods We retrospectively investigated 206 stage pN2/Ⅲ NSCLC patients who underwent lobectomy/pneumonectomy as well as mediastinal lymph node resection. The N2 lymph node metastasis status was recorded and mediastinal lymph node ratio (MLNR) was calculated as well. Kaplan-Meier and Cox proportional hazard model analyses were then performed to analyze the associations between N2 lymph node metastasis status and 5-year overall survival time. Results The median overall survival time of 29.6 months. The Kaplan-Meier analyses showed patients with multiple stations of metastasis, multiple metastatic lymph nodes( 〉 2 nodes), skip N2 metastasis, subcarinal lymph node metastasis or higher MLNR (≥ 33% ) had shorter overall survival time ( P 〈 0.05). Cox proportional hazard model analyses showed positive subcarinal lymph node metastasis ( adjus- ted HR = 1.81,95% CI 1.18-2.79 ,P = 0. 007 ) and MLNR 1〉33% ( adjusted HR = 1.54,95% CI 1.02- 2.33,P = 0. 040) were independent predictors of mortality in NSCLC pN2/Ⅲ patients. Conclusion Multiple stations of metastasis, multiple metastatic lymph nodes, skip N2 metastasis, positive subcarinal lymph node or MLNR≥33% were associated with poorer outcomes,which may be possibly prognostic predictors for pN2/Ⅲ NSCLC patients.
作者
李旸凯
陈滔
李樊
赵波
LI Yangkai CHEN Tao LI Fan et al(Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)
出处
《临床外科杂志》
2016年第12期950-953,共4页
Journal of Clinical Surgery
关键词
非小细胞肺癌
淋巴结转移
预后
no-small cell lung cancer
lymph node metastasis
prognosis