左侧非小细胞肺癌4L组淋巴结转移的临床病理学特征及危险因素分析

Clinicopathological characteristics and risk factors of station 4L lymph node metastasis ofleft non-small cell lung cancer

目的总结分析左侧肺鳞癌和腺癌4L组淋巴结转移的临床病理学特征及4L组淋巴结转移的危险因素。方法回顾性纳入2008年1月~2020年4月在解放军总医院第一医学中心胸外科行左侧肺癌切除+4L组淋巴结清扫的患者134例,依据病理学类型不同分为肺鳞癌组(60例)及肺腺癌组(74例),分析两组间围术期临床病理学特征差异,用logistic回归探讨4L组淋巴结转移的危险因素。结果所有患者4L组淋巴结转移率16.4%(22/134),两组患者在年龄、性别、吸烟史、新辅助化疗、肿瘤大小、肿瘤位置及类型、脏层胸膜侵犯、Ki-67指数、4L组淋巴结转移及病理分期(Ⅱ期)有统计学差异,肺鳞癌患者4L组淋巴结转移率明显低于肺腺癌。单因素分析显示病理类型(鳞癌/腺癌)、肺膜侵犯、脉管癌栓、肿瘤标志物阳性、第5组淋巴结转移、第6组淋巴结转移、第7组淋巴结转移、第8组淋巴结转移、第9组淋巴结转移及第10组淋巴结转移是4L组淋巴结转移的高危因素,多因素分析发现,病理类型(鳞癌/腺癌)(OR=0.120,P=0.025)、第5组淋巴结转移(OR=18.784,P=0.007)及第10组淋巴结转移(OR=5.233,P=0.044)为4L组淋巴结转移的独立危险因素。结论左侧肺癌出现4L组淋巴结转移并不少见,肺腺癌更易出现,在评估周围结构损伤风险较低,且4L组淋巴结转移可能性较大后应当予以清扫。

Objective To analyze the clinicopathological characteristics and risk factors of 4L lymph node metastasis in left non-small cell lung cancer.Methods We retrospectively analyzed the data of 134 patients undergoing surgical resection of left non-small cell lung cancer and 4L lymph node dissection,including 60 patients with squamous cell carcinoma(SCC)and 74 with lung adenocarcinoma(ADC).The clinicopathological characteristics of the patients were analyzed,and logistic regression analysis was used to identify the predictors of station 4L metastasis.Results Of these patients,16.4%(22/134)presented with station 4L metastasis.The patients with SCC and ADC showed significant differences in age,gender,smoking history,neoadjuvant chemotherapy,tumor size,tumor location and type,visceral pleural invasion,Ki-67 index,4L metastasis and pathological TNM stage(stage II).The rate of station 4L metastasis was significantly lower in SCC group than in ADC group.Univariate analysis revealed that pathological types(SCC or ADC),visceral pleural invasion,lymphovascular invasion,tumor markerabnormality,and station 5 to 10 metastasis were all high-risk factors for station 4L metastasis.Multivariate analysis suggested that the pathological type(OR=0.120,P=0.025),station 5 metastasis(OR=18.784,P=0.007)and station 10 metastasis(OR=5.233,P=0.044)were independent risk factors for 4L metastasis in patients with left non-small cell lung cancer.Conclusion In patients with left non-small cell lung cancer,station 4L metastasis is not rare and is more likely to occur in patients with lung adenocarcinoma.Dissection of the 4L lymph nodes should be performed in cases with low risk of damages of the adjacent tissues and high risk of station 4L metastasis.