cT_(1)N_(0)M_(0)肺腺癌肺段间淋巴结转移及临床特点分析

Analysis of segmental lymph node metastasis and clinical features in cT_(1)N_(0)M_(0) lung adenocarcinoma

目的探讨肺腺癌肺段间淋巴结转移的规律、临床特点及肺段切除术的适应证。方法选择2014年1月至2020年4月该院收治的cT_(1)N_(0)M_(0)肺腺癌患者200例,均接受标准肺叶切除和纵隔淋巴结廓清术。对各组淋巴结进行取样,然后结合临床特征分析段外淋巴结(iLSN)的转移状态及其影响因素。结果单因素分析结果显示,无iLSN转移组与有iLSN转移组在肿瘤最大径、最大标准摄取值(SUV_(max))、癌胚抗原(CEA)、结节类型、病理亚型和N_(1)淋巴结转移方面比较差异有统计学意义(P<0.05)。多因素回归分析结果显示,肿瘤最大径为2.1~3.0 cm,SUV_(max)≥2.5,CEA>4.5 ng/ml,结节类型为非纯磨玻璃结节和N_(1)淋巴结转移是发生iLSN转移的独立危险因素(P<0.05),而病理亚型原位腺癌(AIS)/微浸润腺癌(MIA)/以贴壁生长方式为主的腺癌(LPA)则是iLSN转移的独立保护因素。结论对于CEA≤4.5 ng/ml,SUV_(max)<2.5且肿瘤最大径不超过1 cm的纯磨玻璃结节,其冰冻病理证实为AIS/MIA/LPA的患者,行肺段切除术可能是更好的选择。但当术中病理证实N_(1)淋巴结是阳性结果时,需加行肺叶切除术。

Objective To explore the regularity and clinical characteristics of segmental lymph node metastasis in lung adenocarcinoma,and the indications of segmentectomy of lung.Methods Two hundred patients with cT_(1)N_(0)M_(0) lung adenocarcinoma who were admitted to the First Affiliated Hospital of China Medical University from January 2014 to April 2020 were selected,and all the patients received standard lung lobectomy and mediastinal lymph node dissection.The lymph nodes were sampled in each group,and then the metastatic status of isolated segmental lymph nodes(iLSN)and its influencing factors were analyzed by combining with the clinical features.Results The results of univariate analysis showed that there were significant differences in maximum tumor diameter,maximum standardized uptake value(SUV_(max)),serum carcinoembryonic antigen(CEA),nodule type,pathological subtype and N_(1) lymph node metastasis between the non-iLSN metastasis group and the iLSN metastasis group(P<0.05).The results of multivariate regression analysis showed that the maximum tumor diameter of 2.1-3.0 cm,SUV_(max)≥2.5,CEA>4.5 ng/ml,nodule type of non-simple ground glass nodule and N_(1) lymph node metastasis were the independent risk factors for the occurrence of iLSN metastasis(P<0.05),while the pathological subtypes of adenocarcinoma in situ(AIS),microinvasive adenocarcinoma(MIA)and lepidic adenocarcinoma(LPA)were the independent protective factors for iLSN metastasis.Conclusion Segmentectomy of lung might be a better choice for patients with CEA≤4.5 ng/ml,SUV_(max)<2.5 and the largest tumor diameter of simple ground glass nodules not more than 1 cm,and the tumors confirmed by frozen pathology as AIS/MIA/LPA.However,when intraoperative pathology confirms that N_(1) lymph nodes are positive,lobectomy of lung should be added.