淋巴结清扫数量对pN0期非小细胞肺癌患者预后的影响

Influence of the number of lymph node dissection on the prognosis of patients with pN0 stage non-small cell lung cancer

目的探讨淋巴结清扫数量对无淋巴结转移(pN0期)的非小细胞肺癌(NSCLC)患者的预后意义。方法选择536例pN0期NSCLC患者为研究对象,收集患者临床资料并随访,根据淋巴结清扫数量,将患者分为0~11组172例(32.1%),12~16组201例(37.5%),≥17组163例(30.4%),统计分析淋巴结清扫数量对患者总体生存率(OS)及并发症发生率的影响。结果全组患者中位随访时间48个月(3~98个月),5年OS为51.4%。0~11组、12~16组、≥17组患者的5年OS分别为46.2%、49.9%、58.7%。患者OS随检查淋巴结数目的增加而依次增加,差异有统计学意义(χ^(2)=5.126,P=0.009),两两比较后发现,≥17组患者的OS显著好于0~11组(P<0.05),但与12~16组的OS无明显差异(P>0.05)。Cox多因素分析发现,淋巴结清扫数量、T分期、肿瘤大小和纵隔淋巴结清扫站数是影响患者预后的独立性因素(P<0.05)。受试者工作特征曲线分析结果显示,淋巴结清扫数目≥17预测患者预后的灵敏度为0.565,特异度为0.698,曲线下面积为0.643。全组患者术后并发症发生率为11.6%(62/536),主要包括肺部感染18例、肺不张10例、呼吸衰竭7例、心律失常12例、心力衰竭5例、切口感染4例、低血压3例、血胸1例、脓胸1例、支气管胸膜瘘1例。Logistic回归分析显示,淋巴结清扫数目对术后并发症发生率无明显影响(P>0.05)。结论淋巴结清扫数量是pN0期NSCLC患者的独立预后因素,在临床中应充分清扫淋巴结以改善pN0期NSCLC患者的预后。

Objective To investigate the prognostic significance of the number of lymph node dissection in patients with pN0 stage NSCLC.Methods A total of 536 patients with pN0 NSCLC were enrolled.According to the number of lymph node dissection,the patients were divided into the 0~11 group(172 cases),the 12~16 group(201 cases)and the≥17 group(163 cases).Results The median follow-up time was 48 months(3~98 months).The 5-year OS was 51.4%.The 5-year OS of the 0~11 group,the 12~16 group and the ≥17 group were 46.2%,49.9% and 58.7% respectively.The OS of patients increased with the increase of the number of lymph nodes examined.After pairwise comparison,the OS of the≥17 group was significantly better than that of the 0~11 group and the 12~16 group(P<0.05),but there was no significant difference between the 0~11 group and the 12~16 group(P>0.05).Cox multivariate analysis showed that the number of lymph node dissection,T stage,tumor size,and number of mediastinal lymph node dissection stations were independent prognostic factors(P<0.05).ROC curve analysis results showed that the sensitivity of the number of lymph node dissections≥17 to predict the prognosis of patients was 0.565,the specificity was 0.698,and the area under the curve was 0.643.The incidence of postoperative complications was 11.6%(62/536),including 18 cases of pulmonary infection,10 cases of atelectasis,7 cases of respiratory failure,12 cases of arrhythmia and 5 cases of heart failure.Logistic regression analysis showed that the number of lymph node dissection had no significant effect on the incidence of postoperative complications(P>0.05).Conclusion The number of lymph node dissection is an independent prognostic factor for patients with pN0 stage NSCLC.It is necessary to fully remove lymph nodes in order to improve the prognosis of patients with pN0 stage NSCLC.