非小细胞肺癌跳跃性N2转移的特点

Investigating the characteristics of skip N2 metastasis in NSCLC

目的探讨非小细胞肺癌跳跃性N2转移患者的临床和病理特点,为肺癌手术治疗临床决策提供理论依据。方法2017年1月至2018年5月期间手术治疗120例N2转移的非小细胞肺癌患者,其中男55例,女65例;年龄(58.36±11.34)岁。36例为跳跃性N2转移,约占N2淋巴结阳性患者的30%。48例有吸烟史或明确的二手烟接触史。收集患者术前、术后临床资料,并进行相关统计学分析。结果跳跃性N2转移的非小细胞肺癌中,右下肺周围型肺癌更为多见,病理类型以腺癌为主,主要生长方式为腺泡样生长。跳跃性转移多为单站转移。相比于非跳跃性N2淋巴结转移患者,跳跃性N2淋巴结转移组患者年龄较大[(61.47±10.63)岁对(57.02±11.43)岁,P=0.049]。两组间性别、吸烟史、肿瘤T分期、病理类型、累及肺膜等差异均无统计学意义(P>0.05)。结论高龄患者较易出现跳跃性转移,跳跃性转移的NSCLC多见于右下肺周围型肺腺癌,出现跳跃性转移的肺腺癌生长方式以腺泡样生长为主,且多为单站N2淋巴结转移。右上肺癌常跳跃转移至R2+R4组,右中肺癌多跳跃转移至R2+R4及第7组,双下肺癌多跳跃至第7组;左上肺癌多跳跃转移至第5组。

Objective To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center, therefore guide for clinical decision making for NSCLC patients. Methods A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018, of which 55 were males and 65 were females. The mean age of them were (58.36±11.34) years old. 36 patients had skip N2 metastasis, accounting for 30% of patients with N2 metastasis. 48 patients had a history of smoking or a definitive history of second-hand smoke exposure, compared with other 72 patients. Collected pre- and post-operation clinical data of those patients, and carried out relevant statistical analysis. Results Among the NSCLC with skip N2 metastasis, it occulted more frequently in right lower lobe and peripheral lung cancer. The main pathological type was adenocarcinoma with acinar subtype. The most cases of skip N2 metastasis were characterized by single N2 station metastasis. Age of patients showed a significant difference between the two groups(P=0.049). Gender, smoking history, T staging of lung cancer, pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P>0.05). Conclusion Patient with skip N2 metastasis seemed to be elder, and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer, often involved single N2 station. The lung cancer in right upper lobe often skipped to level R2+ R4, which in right middle lobe often skipped to levels R2+ R4 and 7, in right and left lower lobes skipped to level 7, in the left upper lobe often skipped to level 5.