pN2期肺腺癌淋巴结转移影响因素及基因突变分析

Analysis of factors affecting lymph node metastasis and gene mutation in pN2 stage lung adenocarcinoma

目的 分析肺腺癌患者淋巴结转移的影响因素及基因突变情况,以提高术前N分期的准确性,为肺癌患者后续治疗提供理论参考。方法 回顾性分析2018年6月至2020年6月内江市第一人民医院收治的pN2期肺腺癌且行EGFR突变检测的患者119例,比较N2期(32例)和N0期(87例)患者的各项临床资料,分析pN2期肺腺癌淋巴结转移的危险因素,并探讨其EGFR突变差异。结果 N2期和N0期患者肿瘤最长径、气道播散、胸膜受累等方面,差异有统计学意义(P<0.05)。肿瘤最长经、气道播撒、胸膜受累是pN2期肺腺癌(直径≤3 cm)患者淋巴结转移的独立危险因素(P<0.01)。N2与N0期肺腺癌患者EGFR、KRAS基因突变率比较差异无统计学意义(P>0.05)。结论 早期肺腺癌患者淋巴结转移的独立危险因素主要有肿瘤最长经、气道播散、胸膜受累,N2期患者与N0期患者的基因表达无明显差异。

Objective To analyze the influencing factors of lymph node metastasis and gene mutation in patients with lung adenocarcinoma in order to improve the accuracy of preoperative N staging and provide theoretical reference for follow-up treatment of lung cancer patients.Methods Clinical data of 119 patients with pN2 stage lung adenocarcinoma who underwent EGFR mutation detection in Neijiang First People′s Hospital from June 2018 to June 2020 were retrospectively analyzed. The clinical data of patients with N2 stage(n=32) and No stage(n=87) were compared. The risk factors of lymph node metastasis of pN2 stage lung adenocarcinoma were analyzed, and the differences of EGFR mutations were investigated.Results There was a significant difference between the N2 stage and the No stage patients in the longest diameter of tumor, airway spread and pleural involvement(P<0.05). The longest diameter of tumor, airway spread and pleural involvement were independent risk factors for lymph node metastasis in the patients with pN2 stage lung adenocarcinoma(diameter ≤ 3 cm)(P<0.01). There was no significant difference in EGFR and KRAS gene mutation rates between N2 and N0 lung adenocarcinoma patients(P>0.05).Conclusions The independent risk factors of lymph node metastasis in patients with early lung adenocarcinoma are mainly the longest diameter of tumor airway spread and pleural involvement. There is no significant difference in gene expression between N2 stage patients and No stage patients.