Ⅲ期非小细胞肺癌纵隔淋巴结跳跃式转移的临床意义  

Skip metastasis to mediastinal lymph nodes: clinical significance and prognosis in stage Ⅲ non-small cell lung cancer

作　　者：陈乾坤[1] 丁嘉安[1] 高文[1] 朱余明[1] 

机构地区：[1]上海市肺科医院胸外科,200433

出　　处：《中华结核和呼吸杂志》2005年第7期472-474,共3页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨Ⅲ期非小细胞肺癌(NSCLC)患者纵隔淋巴结跳跃式转移的临床意义。方法65例术后病理证实的NSCLC患者,分为纵隔淋巴结(pN2期)跳跃转移组(21例)及非跳跃转移组(44例),回顾分析两组患者的临床、手术及病理资料。结果两组患者的性别、年龄及肿瘤的病理类型、大小、部位和术后转移情况差异无统计学意义(P均>0·05);非跳跃转移组发生多组淋巴结转移的概率为36.4%(16/44)显著高于跳跃转移组的9.5%(2/21;χ2=8·571,P=0·036)。跳跃转移组患者术后平均生存时间为44个月,5年生存率为41%;非跳跃转移组术后平均生存时间为26个月,5年生存率为21%,两者差异有统计学意义(χ2=9·325,P<0·05)。纵隔淋巴结跳跃式转移可以作为肺癌术后一个独立的预后因素(P=0·003,RR=0·347)。结论纵隔淋巴结跳跃式转移的临床Ⅲ期NSCLC患者生存期较无跳跃式转移的患者长,纵隔淋巴结跳跃式转移可以作为一个独立的生存预后因素;跳跃式转移可能是pN期肺癌中的一个亚群。Objective To analyze the significance and prognosis of skip metastasis to mediastinal lymph nodes in stage Ⅲ non-small cell lung cancer (NSCLC). Methods The data of 65 patients who underwent resection for NSCLC with a pN2-stage were analyzed retrospectively. Twenty-one of these patients (32.3%), showing no metastatic involvement of hilar (N1) lymph nodes, were compared to the remaining 44 patients with infiltration of hilar nodes (N1) as well as N2 nodes. Software SPSS 10.0 was used for statistical analysis. Results Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N2 group regarding sex, age, histology, location, and T- or M-status. In the skip metastasis group, mediastinal node metastasis was found in ≥2 region in 16 patients (36.4%) and in continuous N2 group in 2 patients(9.5%, χ2=8.571, P=0.036). The 5-year survival rate of pN2 patients with skip metastasis was 41% compared to 21% in patients with involvement of N1 and N2 nodes ( P=0.022 6),and the mean survival time was 44 months and 26 months respectively. Conclusions pN2 patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN2 patients with continuous infiltration of the regional lymph nodes. Skip metastasis is an independent prognostic factor for survival. Skip metastasis may represent a subgroup of pN2 classification.

关 键 词：跳跃式转移 纵隔淋巴结 Ⅲ期非小细胞肺癌 临床意义 非小细胞肺癌(NSCLC) 5年生存率 LC患者 生存时间 预后因素 转移组 淋巴结转移 病理证实 回顾分析 病理资料 病理类型 肺癌术后 N2期 统计学 生存期 平均 

分 类 号：R734.2[医药卫生—肿瘤]