pN2／Ⅲ期非小细胞肺癌五年生存期与纵隔淋巴结转移相关性的回顾性分析

Correlation between 5-year survival of pN2/Ⅲ stage no-small cell lung cancer and mediastinal lymph node metastasis patients

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.