cTNM-Ⅰ期非小细胞肺癌肺叶特异性纵隔淋巴结转移规律的探讨

Study of clinical indications of lobe-specific mediastinal lymph node dissection in patients with non-small-cell lung cancer of cTNM-Ⅰ stage

目的:目前对于早期非小细胞肺癌(non-small-cell lung cancer,NSCLC)纵隔淋巴结转移模式的研究尚少。本研究旨在了解这些患者的不同临床特征是否会引起肺叶特异性淋巴结转移率和非特异性纵隔淋巴结转移率的不同变化,从而推测在早期NSCLC患者中行单纯肺叶特异性淋巴结清扫的临床适应证。方法:调查了609例肺叶切除术和系统纵隔淋巴结清扫的c TNM-Ⅰ期的NSCLC患者。从临床资料包括肿瘤大小、肿瘤的组织学类型、性别和年龄等方面来分析肺叶特异性纵隔淋巴结转移率和非特异性纵隔淋巴结的转移率。结果:符合以下特点的Ⅰ期NSCLC患者的纵隔淋巴结转移大部分被限制在了肺叶特异性纵隔淋巴结:(1)男性,年龄>60岁,鳞状细胞癌,肿瘤最大径≤5 cm;(2)男性,年龄≤60岁,鳞状细胞癌,肿瘤最大径≤3 cm;(3)女性,鳞状细胞癌,肿瘤最大径≤3 cm;(4)腺癌,肿瘤最大径≤2 cm。结论:符合以上条件的术前c TNM-Ⅰ的NSCLC患者的纵隔淋巴结转移大部分局限于肺叶特异性淋巴结,对于这些患者,单纯清扫其肺叶特异性淋巴结是足够的;而其他患者出现肺叶非特异性纵隔淋巴结转移的风险将会明显升高,对于这类患者,系统的淋巴结清扫仍是最为有效的方法。

Objective： At present, there are few studies on the metastasis model of mediastinal lymph node（MLN） in stage I non-small-cell lung cancer（ NSCLC）. This study aimed to identify if patients with different clinical characteristics have different changes in metastatic rates between lobe-specific and non-specific MLN stations in patients with preoperative stage I NSCLC, so as to predict clinical indications of lobe-specific MLN dissection in patients with preoperative stage I NSCLC. Methods： We examined 609 patients with clinical stage I NSCLC for lobectomy with complete MLN dissection. We analyzed the metastatic rates of lobe-specific and other MLN stations with patient characteristics, including T stage, tumor histology, gender and age. Results： It was revealed that metastasis was limited to lobe-specific MLNs for stage Ⅰ patients meeting the following criteria：（1）male, 〉 60 years, squamous cell tumor, and tumor≤5cm.（2）male, ≤60 years, squamous cell tumor, and tumor≤ 3 cm.（3）female, squamous cell tumor, and tumor≤3 cm.（4）adenocarcinoma and tumor≤2 cm. Conclusion： Lobe-specific mediastinal lymph node MLN dissection is suitable for the patients with characteristics mentioned above. For other patients, there was a considerable increasing risk of metastasis, and complete MLN dissection remains the most effective method.