对于肺腺癌形态及成分与淋巴结转移规律的关系

Correlation factors of N1 lymph node metastasis in patients with lung adenocarcinoma

目的 探讨肺腺瘤形态大小,微乳头成分、实性成分与淋巴结转移之间的关系.方法 回顾性分析肺腺癌手术患者临床资料与淋巴结转移情况.使用SPSS 19.0统计软件,通过x2检验fisher精确检验分析引起淋巴结转移的因素,并用logistic多因素分析总结独立影响因素,ROC曲线分析计算阈值.结果 N1淋巴结转移单因素分析结果显示：性别（P=0.016）、肿瘤直径（P =0.001）、胸膜侵犯情况（P=0.008）、微乳头成分（P =0.028）和实性成分（P =0.047）具有统计学意义.多因素分析结果显示,微乳头成分、实性成分及肿瘤大小是影响肺腺癌N1淋巴结转移的独立危险因素.经ROC曲线计算,微乳头成分＞27.5％,实性成分＞15％,肿瘤直径＞3.0 cm,为N1淋巴结转移阈值.关于N1淋巴结单站与多站转移规律,单因素分析结果显示,术前CEA升高（P =0.004）、血管内见癌栓（P =0.029）、微乳头成分（P=0.018）有统计学意义;多因素分析示术前升高的CEA和微乳头成分是独立的危险因素,术前CEA高于正常值或者微乳头成分越高,越有可能出现多站N1转移;ROC结果显示,微乳头成分大于30％即有可能出现多站N1转移.关于肺内N1淋巴结与肺外N1淋巴结转移规律经单因素分析只有微乳头成分（P =0.027）具有统计学意义,微乳头成分高说明腺癌有可能已转移至肺外淋巴结.结论 肿瘤直径、微乳头成分和实性成分为肺腺癌N1淋巴结转移危险因素,术前较高的CEA值或者微乳头成分越高,可出现多站N1转移.

Objective The mechanism of the lymph node metastasis in lung adenocarcinoma is unknown.The characteristic of the N1 and N2 lymph nodes metastasis are different.We explore the relationship between the N1 lymph node metastasis and clinicopathological factors in lung adenocarcinoma patients.Methods Data of 126 patients who had received lobectomy and systematic lymph node dissection were retrospectively analyzed.Chi-square test and Fisher exact method was used in univariate analysis,logistic regression was performed to analyze the multivariate analysis.Critical value was calculate in ROC.All the methods executed in software SPSS 19.0.Results After analyzed the N1 lymph node metastasis and clinicopathological factors,sex （P =0.016）,diameter of tumor （P =0.001）,pleural invasion （P =0.008）,micropapillary pattern （P =0.028）,solid pattern （P =0.047） has statistical significance in univariate analysis.Logistic regression analysis reveal diameter of tumor,micropapillary pattern and solid pattern were independent risk factors for N1 lymph nodes.CEA level （P =0.004）,cancer embolus （P =0.029）,micropapillary pattern （P =0.018）,affect the groups （number of metastasis station） of the metastasis lymph nodes.Logistic regression analysis find CEA and micropapillary pattern were independent risk factors,which might lead multiple groups lymph nodes metastasis.There is only one factor could impact the location of the N1 lymph node metastasis,which is micropapillary pattern （P =0.027）.Conclusion Via ROC results,there are three factors affect the N1 lymph nodes metastasis：purity of micropapillary pattern more than 27.5%,purity of solid pattern more than 15%,diameter of tumor larger than 3.0 cm.If a lung adenocarcinoma patient who was in early stage has one or more than one factors,we suggest chemotherapy followed the surgery.Higher CEA level or higher content of micropapillary pattern much more groups lymph nodes metastasis might appear,so radiotherapy and other method should be considered to added on.High content of micropapillary pattern maybe imply cancer cell has already invaded extra pulmonary lymph nodes.