淋巴结转移数和病灶大小在可手术非小细胞肺癌预后中的意义  

Significance of the number of positive lymph nodes and size of primary lesion for prognosis of resected non-small cell lung cancer

作　　者：陆舜[1] 虞永峰[1] 吴春晓[2] 李子明[1] 周允中[1] 郑莹[2] 赵晓菁[1] 廖美琳[1] 

机构地区：[1]上海交通大学附属胸科医院上海市肺部肿瘤临床医学中心 [2]上海市疾病预防控制中心肿瘤防治科,上海200336

出　　处：《肿瘤》2007年第12期973-976,共4页Tumor

摘　　要：目的:研究淋巴结转移数目和病灶大小等因素在可手术非小细胞肺癌患者预后中的意义。方法:173例Ⅰa～Ⅲa期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者,其中59例接受了系统淋巴结清扫术,114例行淋巴结采样术。测量原发病灶的大小,检测淋巴管癌栓等的情况,根据转移淋巴结数目及病灶的大小的不同进行分组。所有资料应用SPSS10.0软件进行统计分析,生存分析采用Kaplan-Meier方法,COX回归模型进行多因素分析。结果:术中共切取淋巴结1033枚,x-±s为(5.97±0.20)枚,其中转移淋巴结共244枚(24%),x-±s为(1.41±0.16)枚。173例患者中有45例死亡,2年生存率为71.9%。生存分析提示淋巴结转移枚数与可手术NSCLC预后密切相关,在pN2患者中若淋巴结转移枚数越多则预后越差(P=0.016);pN2患者中不同纵隔淋巴结转移站数间的生存差异有统计学意义(P=0.048);pN2患者的淋巴结跳站转移与非跳站转移间的生存差异无统计学意义(P=0.737)。原发病灶<3cm,≥3cm且<4cm,≥4cm且<5cm,≥5cm4组间生存期差异有统计学意义(P<0.001)。另外,COX多因素分析提示淋巴管癌栓是可手术NSCLC预后的重要影响因素(P=0.041)。结论:增加对淋巴结转移枚数定义,进一步细化对原发病灶大小的定义以及考虑肿瘤对淋巴管侵犯对分期的影响等,可能会有利于进一步完善国际肺癌分期。Objective：To investigate the significance of the number of positive lymph nodes （LNs） and size of primary lesion for the prognosis of resected non small cell lung cancer （NSCLC）. Methods. One hundred seventy-three NSCLC patients at pathological stage Ⅰa-Ⅲa were recruited in this study. Fifty-nine patients received systematic lymphadenectomy and one hundred fourteen patients underwent limited lymph node sampling. The size of primary lesions was measured and the lymph vessel embolus was examined. The patients were divided according to the number of positive lymph nodes and size of primary lesions. The statistical analysis was performed by using SPSS 10.0 software. The survival function was analyzed by Kaplan-Meier method. COX regression model was used to analyze the multiple risk factors influencing the prognosis of NSCLC. Results：Totally 1 033 lymph nodes were resected in operation, mean（^-x ± s） was 5.97 ±0.20. There were 244 metastatic lymph nodes, mean（^-x ±s） was 1.41 ±0. 16. Forty-five patients died. The 2-year survival rate was 71.9%. Survival analysis suggested that LNs were closely related with the prognosis of resected NSCLC. For the patients with pN2 disease, more positive LNs indicated poorer prognosis （P =0.016 ）. The survival difference was significant between the pN2 patients who had different numbers of metastatic station of mediastinal lymph nodes （ P = 0.048 ）. The difference was not significant between the pN2 patients with or without lymph node skip metastasis （ P = 0.737 ）. There was significant difference in survival time be- tween the patients who had different sizes of primary lesions （ 〈 3 cm;≥3 cm and 〈 4 cm ;≥4 cm and 〈 5 cm≥15 cm, P 〈 0.001 ）. COX regression analysis showed that lymph vessel embolus was an important prognostic factor for resected NSCLC （P = 0.041 ）. Conclusions：It will be beneficial to improve the international staging system of lung cancer by increasing the correlated definition on the number of positive LN

关 键 词：癌 非小细胞肺 淋巴转移 肿瘤分期 预后 

分 类 号：R734.2[医药卫生—肿瘤] R730.7[医药卫生—临床医学]