病理T1期孤立性非小细胞肺癌淋巴结转移特征及其影响因素

Clinicopathological features and risk factors for lymphatic metastasis in pathological T1 primary isolated non-small cell lung cancer

目的探讨病理T1期(pT1期)孤立性非小细胞肺癌(NSCLC)淋巴结转移特征及其影响因素,为临床治疗方式的选择提供依据。方法对681例pT1期NSCLC患者的淋巴结转移特征进行分析,并采用logistic回归分析pT1期NSCLC发生淋巴结转移的危险因素。结果 pT1期NSCLC淋巴结转移率为10.1%(69/681),纵隔淋巴结跳跃性转移发生率为2.3%(16/681)。男性、肿瘤为中央型、位于右下肺及左下肺、pT1b和pT1c、侵犯肺膜、静脉内有癌栓、侵犯支气管、组织学类型为鳞癌和其他型的NSCLC患者淋巴结转移率较女性、周围型、右上中肺及左上肺、pT1a、未侵犯肺膜、静脉内无癌栓、未侵犯支气管、组织学类型为腺癌的患者高,差异均有统计学意义(均P<0.05);多因素logistic回归分析显示肿瘤为中央型、pT1c、侵犯肺膜、静脉内有癌栓是发生淋巴结转移的危险因素(均P<0.05)。女性及肿瘤位于左上肺的NSCLC患者跳跃式淋巴结转移率较男性及肿瘤于其他部位的患者高,差异均有统计学意义(均P<0.05)。结论影响NSCLC淋巴结转移的独立危险因素为肿瘤大小、肿瘤生长部位、肿瘤类型、侵犯肺膜及静脉内有癌栓。对于周围型、肿瘤直径≤1.0cm、未侵犯肺膜的NSCLC建议采用淋巴结取样或选择性淋巴结清扫术。

Objective To investigate the clinicopathological features and risk factors for lymphatic metastasis ofpathological T1primary isolated non-small cell lung cancer(NSCLC).Methods The clonicopathological features of lymphaticmetastasis in681cases of pT1NSCLC were retrospectively analyzed.Logistic model was used to analyze the risk factors forlymphatic metastasis.Results The lymphatic metastasis rate of pT1NSCLC was10.1%(69/681),while the rated of skipmetastasis to mediastinal lymph node was2.3%(16/681).Lymphatic metastasis rate in male patients,with central type,in lowerright lung and lower left lung,T1a and squamous cell carcinomas was higher than that in female patients,with peripheral type,inupright left and right lung,T1b and T1c,and adenocarcinoma(all P<0.05).Multivariate Logistic regression model showed that thecentral type,pT1c,pleural invasion,intravenous invasion were the risk factors for lymphatic metastasis(all P<0.05).FemaleNSCLC patients with a tumor located in the upper left lung had higher skip lymphatic metastasis rate(all P<0.05).ConclusionThetumor size,tumor position,tumor type,pleural andvenous invasionareindependent risk factors for lymphaticmetastasis inNSCLCpatients.Peripheral NSCLCpatients withatumor of1.0cmor less in diameter,andnopleural invasionshouldbe recommendfor lymphnodesamplingorselectivelymphnodedissection.