非小细胞肺癌纵隔淋巴结转移规律的临床研究  

Clinical study on the metastatic patterns of mediastinal lymph node in non-small-cell lung cancer

作　　者：钟清木[1] 陈子龙[1] 王开铭[1] 

机构地区：[1]福建医科大学附属泉州市第一医院肿瘤放疗科,362000

出　　处：《肿瘤研究与临床》2013年第7期469-471,474,共4页Cancer Research and Clinic

摘　　要：目的 分析非小细胞肺癌（NSCLC）纵隔淋巴结转移规律，探讨NSCLC放射治疗靶区的勾画范围。方法 对291例NSCLC患者治疗前行纵隔CT增强扫描，分析纵隔各分区淋巴结转移的发生率，探索NSCLC纵隔淋巴结转移发生的规律。结果 152例右肺NSCLC患者中发生同侧锁骨上淋巴结转移24例，发生率15.8 %，对侧锁骨上淋巴结转移10例，发生率6.6 %，纵隔淋巴结转移率最高的是同侧肺门淋巴结，为59.2 %，其次为4R区（56.6 %）、1~2R区（36.2 %）、7区（33.6 %）、4L区（20.4 %）、10~11L区（5.9 %）、6区（3.9 %）、5区（2.0 %）、1~2L区（2.0 %），左肺NSCLC 139例中发生同侧锁骨上淋巴结转移22例，发生率15.8 %，对侧锁骨上淋巴结转移8例，发生率5.8 %，纵隔淋巴结转移率最高的也是同侧肺门淋巴结，为54.0 ％，其次是7区（33.8 %）、4R区（26.6 %）、4L区（24.5 %）、1~2R区（15.8 %）、 5区（10.8 %）、6区（9.4 %）、1~2L区（5.8 %）、10~11R区（5.0 %）。结论 左右肺叶NSCLC具有不同高危纵隔淋巴结转移区域，对这些高危区域进行选择性预防照射，有助于降低复发率，提高局部控制率。Objective To explore the reasonable clinical target volumes by analyzing the characteristic of mediastinal lymph node metastases in non-small-cell lung cacer （NSCLC）. Methods 291 NSCLC patients was performed pre-therapy CT scans, and the incidence of mediastinal lymph node metastases was analysed. Results Among the 152 patients with right lung NSCLC, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 15.8 % （24/152）, and the incidence of involvement of the contralateral lymph nodes was 6.6 % （10/152）. The highest incidence of mediastinal nodal involvement occurred in the ipsilateral hilar nodes （59.2 %）, followed by area 4R （56.6 %）, area 1-2R （36.2 %）, area 7 （33.6 %）, area 4L（20.4 %）, area 10-11L （5.9 %）, area 6 （3.9 %）, area 5 （2.0 %）, area 1-2L （2.0 %）, respectively. Among the 139 patients left lung NSCLC, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 15.8 % （23/139）, and the incidence of involvement of the contralateral lymph nodes was 5.8 % （8/139）. The highest incidence of mediastinal nodal involvement occurred also in the ipsilateral hilar nodes （54.0 %）, followed by area 7 （33.8 %）,area 4R （26.6 %）, area 4L （24.5 %）, area 1-2R （15.8 %）, area 5 （10.8 %）, area 6 （9.4 %）, area 1-2L （5.8 %）,area 10-11R （5.0 %） respectively. Conclusion The right side primaries or left side primaries of NSCLC have different high risk lymph node areas for metastasis, and selective irradiation to these lymph node areas maybe increase the tumor control rate and reduce the recurrence rate.

关 键 词：癌 非小细胞肺癌 放射疗法 肿瘤转移 纵隔淋巴结 放疗靶区 

分 类 号：R734.2[医药卫生—肿瘤]