T1期周围型非小细胞肺癌纵隔淋巴结转移规律的分析

Analysis of mediastinal lymph node metastasis in peripheral T1 stage non-small cell lung cancer

目的探讨T1期周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者纵隔淋巴结转移规律,进而指导临床淋巴结清扫方式。方法回顾性分析潍坊市人民医院2012年1月至2016年3月收治的276例T1期周围型NSCLC患者的临床资料。所有患者都进行了系统性淋巴结清扫,统计淋巴结清扫个数及转移个数,分析纵隔淋巴结转移规律及其与肺癌的病理类型、大小、原发部位及分化程度的相关性。结果 276例肺癌患者中,共清扫出淋巴结4 968枚,平均(4.4±1.7)组,其中有145枚淋巴结发生转移,转移率为2.92%。有58例患者发生纵隔淋巴结转移,转移率为21.01%,其中区域性淋巴结转移55例,占纵隔淋巴结转移的94.83%。鳞癌患者纵隔淋巴结转移率为18.92%,腺癌患者纵隔淋巴结转移率为22.83%,两者差异无统计学意义(χ~2=0.474,P>0.05)。右肺癌纵隔淋巴结转移率与左肺癌比较,上肺癌纵隔淋巴结转移率与下肺癌比较,均差异无统计学意义(χ~2=1.904,P>0.05;χ~2=0.099,P>0.05)。随着T分期的增加,纵隔淋巴结转移率逐渐增大。当肿瘤处于T1a期时未发现纵隔淋巴结转移,T1b期高分化鳞癌患者也未发现纵隔淋巴结转移。高、中、低分化癌患者纵隔淋巴结转移率分别为10.10%、25.49%、29.33%,纵隔淋巴结转移率差异有统计学意义(χ2=10.14,P<0.05)。结论 T1期周围型肺癌纵隔淋巴结转移与肿瘤的大小及分化程度相关,大多遵循区域性转移的规律,跨区域淋巴结转移发生率较低。T1a期肺癌和T1b期高分化鳞癌患者纵隔淋巴结转移率较低。根据纵隔淋巴结的转移规律,术中可适当放宽淋巴结的清扫。

Obcective To investigate the metastatic pattern of mediastinal lymph nodes in patients with non-small cell lung cancer（ NSCLC） in T1 stage,and then to guide the clinical lymph node dissection. Methods The clinical data of 276 patients with peripheral TSC type NSCLC admitted to Weifang Peoples Hospital between January 2012 and March 2016 were retrospectively analyzed. All patients underwent systematic lymph nod6 e dissection. The number of lymph node dissections and the metastases were counted. The relationship between mediastinal lymph node metastasis patterns and the pathological type,size,primary site and differentiation of lung cancer was analyzed. Results Of 276 lung cancer patients,4 968 lymph nodes were removed,with an average of（ 4. 4 ±1. 7） groups,of which 145 lymph nodes were metastasized. The metastatic rate was 2. 92 %. Mediastinal lymph node metastasis occurred in 58 patients. The metastasis rate was 21. 01 %. Among them,55 were regional lymph node metastases and accounted for94. 83 % of mediastinal lymph node metastases. The metastasis rate of mediastinal lymph nodes was 18. 92 % in patients with squamous cell carcinoma and 22. 83 % in patients with adenocarcinoma,and there was no significant difference between them（ χ^2= 0. 474,P〈0. 05）. The ratio of mediastinal lymph node metastasis in right lung cancer was significantly higher than that in left lung cancer.There was no significant difference in metastasis rate of mediastinal lymph nodes between upper lung cancer and lower lung cancer（ χ^2= 1. 904,P〈0. 05; χ^2= 0. 099,P〈0. 05）. With the increase of T stage,the mediastinal lymph node metastasis rate gradually increased. No mediastinal lymph node metastasis was found when the tumor was in the T1 a phase. Mediastinal lymph node metastasis was not found in patients with well-differentiated squamous cell carcinoma in the T1 b phase. The metastatic rates of mediastinal lymph nodes in patients with high,moderate,and poorly differentiated cancers were 10. 10 %,25. 49%,and 29. 33%,respectively. The statistically significant difference was statistically significant the higher in the metastatic rate of mediastinal lymph nodes（ χ^2= 10. 14,P〈0. 05）. Conclusions Mediastinal lymph node metastasis of T1 stage peripheral lung cancer is related to tumor size and differentiation. Most of them follow the pattern of regional metastasis,and the incidence of transregional lymph node metastasis is low. The metastatic rate of mediastinal lymph nodes in patients with T1 a lung cancer and T1 b well-differentiated squamous cell carcinoma was also low. According to the law of mediastinal lymph node metastasis,lymph node dissection can be appropriately relaxed during the operation.