临床Tis-T1期非小细胞肺癌脏层胸膜受累情况与淋巴结转移的相关性

Correlation between visceral pleural invasion and lymph node metastasis in clinical Tis-T1 non-small cell lung cancer

目的胸膜脏层浸润(VPI)被认为是非小细胞肺癌(NSCLC)患者的预后不良因素。本研究评估临床Tis-T1期NSCLC的VPI与其他临床病理学特征之间的关系,重点评价与淋巴结转移之间的相关性,为术中淋巴结切除范围的选择提供参考。方法回顾性分析2010年1月至2020年12月滨州医学院附属医院胸外科662例临床Tis-T1期NSCLC临床病理特征。根据脏层胸膜侵犯状态分为两组(PL0组和PL1/2组)。比较两组患者的年龄、性别、肿瘤大小、组织学类型、肿瘤分化程度、脉管瘤栓、血清癌胚抗原水平、淋巴结受累情况。结果在662例NSCLC患者中有145例(21.9%)确定为VPI,结果显示肿瘤体积较大以及血清CEA偏高患者更易出现VPI。脏层胸膜受累时淋巴结转移的发生率为31.7%(46/145),明显高于脏层胸膜未受累时淋巴结转移的发生率10%(52/517),P<0.05,说明脏层胸膜受累与淋巴结转移显著相关。脏层胸膜受累病例中出现跳跃性N2转移的概率高于脏层胸膜未受累病例的概率。结论对于临床Tis-T1期NSCLC,脏层胸膜受侵犯与淋巴结转移关系密切,建议对于术前或术中高度怀疑存在脏层胸膜受累时,应考虑淋巴结转移可能性,特别应警惕N2跳跃性转移可能,需要采取更广泛的淋巴结切除,而不仅仅进行N1淋巴结采样。

Objective Visceral pleural invasion(VPI)is considered a poor prognostic factor in patients with non-small cell lung cancer(NSCLC).This study evaluated the relationship between VPI and other clinicopathological features in clinical Tis-T1 non-small cell lung cancer,focusing on the correlation with lymph node metastasis,providing a reference for the selection of the extent of intraoperative lymph node resection.Methods The clinicopathological features of 662 cases of clinical Tis-T1 NSCLC in the Department of Thoracic Surgery,Binzhou Medical University Hospital from January 2010 to December 2020 were retrospectively analyzed.They were divided into 2 groups according to the status of visceral pleural invasion(PL0 group PL1/2 group).The age,gender,tumor size,histological type,tumor differentiation,vascular tumor thrombus,serum carcinoembryonic antigen level,and lymph node involvement were compared between the two groups for statistical analysis.Results VPI was identified in 145 of 662(21.9%)NSCLC patients,and the results showed that patients with larger tumor size and serum CEA were more likely to have VPI.The incidence of lymph node metastasis was 31.7%(46/145)when the visceral pleura was involved,which was significantly higher than the incidence of lymph node metastasis 10%(52/517)when the visceral pleura was not involved,P<0.05,indicating that visceral pleura involvement was significantly associated with lymph node metastasis.The probability of N2 Skip lymph node metastasis occurred in cases with visceral pleural involvement,P<0.05.Conclusion For clinical Tis-T1 non-small cell lung cancer,visceral pleural invasion is closely related to lymph node metastasis.We recommend that the possibility of lymph node metastasis should be considered when there is a high suspicion of visceral pleural involvement during surgery,especially the possibility of N2 skip metastasis.More extensive lymphadenectomy is required,rather than only N1 lymph node sampling.