段淋巴结解剖在非小细胞肺癌病理分期中的作用

Importance of segmental lymph nodes in the pathological staging of non-small cell lung cancer

目的探讨段淋巴结解剖在非小细胞肺癌病理分期中的作用。方法回顾性分析中山大学肿瘤防治中心2008年8月至2016年7月同一手术组总数为370例非小细胞肺癌患者行肺切除加系统纵隔淋巴结清扫的临床资料，分析段淋巴结解剖与病理分期（采用第七版国际抗癌联盟和美国抗癌联合会肺癌分期系统）的联系，探讨段淋巴结解剖在非小细胞肺癌病理分期中的作用。结果肺门淋巴结、叶间淋巴结、叶淋巴结和段淋巴结的检出率分别为69．7％、86．8％、84．O％、67．0％，转移率分别为6．5％、10．8％、15．7％、10．3％。其中有N0期238例，N1期62例、N2期69例、N3期1例。如果忽略了段淋巴结解剖，那么将有16例患者（占N1期25．8％）降至N0期，5例多组的N1期的患者误诊为单组N1期，2例N2期误诊为跳跃性转移。结论段淋巴结在非小细胞肺癌病理分期有重要作用。

Objective To explore the role of the segmental lymph node dissection in the pathologic staging of non-small cell lung cancer. Methods A total of 370 consecutive non-small cell lung cancer patients who underwent radical resection between August 2008 and July 2016 were retrospectively reviewed. All the operations were performed by the same group of surgeons. The relationship of the segmental lymph nodes with pathological stages after radical resection was analyzed in order to explore the role of the lymph node dissection in the pathologic staging of non-small cell lung cancer （ using the 7th edition of the American Joint Committee on Cancer and Union for International Cancer Control TNM classification for lung cancer ）. Results The detection rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 69.7% , 86. 8% , 84. 0% , 67.0% , respectively. The metastasis rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 6. 5% , 10. 8% , 15.7% and 10. 3% , respectively. There were 238 cases of NO disease, 62 cases of N1 disease, 69 cases of N2 disease and 1 case of N3 disease. If the analysis of segmental lymph nodes had been omitted, 16 patients （25.8% of N1 disease） would have been down-staged to NO, and 5 cases of muhiple-station N1 disease would have been misdiagnosed as singlestation N1 disease, 2 patients would have been misdiagnosed as N2 disease with skip metastases. Conclusion Segmental nodes play an important role in the accurate staging of non-small cell lung cancer.