临床Ⅰ期非小细胞肺癌淋巴结转移规律和清扫方式的探讨  

Exploration of lymph node metastasis and appropriate lymph node dissection modes in patients with clinical stage Ⅰ non-small cell lung cancer

作　　者：章智荣[1] 毛友生[1] 赫捷[1] 高树庚[1] 程贵余[1] 刘向阳[1] 方德康[1] 李鉴[1] 王永岗[1] 王大力[1] 牟巨伟[1] 薛奇[1] 高禹舜[1] 赵峻[1] 张良泽[1] 黄进丰[1] 王兵[1] 丁宁宁[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所胸外科,100021

出　　处：《中华肿瘤杂志》2014年第7期536-540,共5页Chinese Journal of Oncology

摘　　要：目的 探讨接受根治性手术治疗的直径≤3 cm的临床Ⅰ期（cⅠ期）原发非小细胞肺癌（NSCLC）的淋巴结转移规律及其可行的淋巴结清扫方式.方法 回顾性分析2012年3月1日至2013年8月31日间270例原发NSCLC患者的临床资料,270例患者的肿瘤直径≤3 cm,术前分期均为cⅠ期,均行系统性淋巴结清扫,分析临床病理特征与淋巴结转移的关系.结果 全组患者术后并发症的发生率为14.8％ （40/270）,无死亡病例.270例患者中,影像学表现为纯磨玻璃样病变（p-GGO） 34例,实性结节189例,混合型47例.结节型病变中肿瘤直径≤1 cm者22例,l cm＜直径≤2 cm者138例,2 cm＜直径≤3 cm者76例.腺癌245例,鳞癌18例,类癌4例,大细胞癌2例,肉瘤样癌1例.全组患者淋巴结转移51例,总淋巴结转移率为18.9％ （51/270）,其中p-GGO、混合型、实性结节型患者的淋巴结转移率分别为0（0/34）、2.1％ （1/47）和26.5％（50/189）;直径≤1 cm、1 cm＜直径≤2 cm和2 cm＜直径≤3 cm肺癌患者中,淋巴结转移率分别为18.2％ （4/22）、14.5％（20/138）和35.5％ （27/76）,差异有统计学意义（P＜0.05）.右肺上叶癌、右肺下叶癌、左肺上叶癌和左肺下叶癌中特异性淋巴结引流区阳性组的非特异性引流区淋巴结转移率分别为30.0％、20.0％、44.4％和50.0％,特异性淋巴结引流区阴性组分别为0、0、0和2.9％,差异均有统计学意义（均P＜0.05）.结论 影像学表现为p-GGO的早期NSCLC一般不发生淋巴结转移,术中可不行系统性淋巴结清扫.对于结节型病变的NSCLC,其淋巴结转移率随肿瘤直径尤其是实性结节成分的增大而增高,当肿瘤直径≤2 cm时,术中可先清扫特异性引流区的淋巴结并行冰冻病理检查,若为阳性,建议行系统性淋巴结清扫;若为阴性,可考虑不进一步行非特异性淋巴引流区的系统性淋巴结清扫.Objective To explore the pattern of lymph node metastasis and evaluate the modes and extent of mediastinal lymph node dissection in patients with ≤3 cm,clinical stage Ⅰ primary non-small cell lung cancer （NSCLC）.Methods Data of 270 eligible patients who underwent pulmonary resection with systematic lymph node dissection in our hospital between March 2012 and August 2013 were retrospectively analyzed in order to investigate the relationship between the clinicopathological features and lymph node metastatic patterns.Patients with multiple primary carcinomas or non-primary pulmonary malignancies and those who received any chemotherapy or radiotherapy or did not undergo systematic nodal dissection were excluded.The criteria of systematic nodal dissection included the removal of at least six lymph nodes from at least three mediastinal stations,one of which must be subcarinal.The data were analyzed and compared using Chi-square test.Results The postoperative morbidity rate was 14.8％ and no death occurred in this series.The imaging findings showed 34 cases of pure ground glass opacity lesions,47 partial solid nodules,and 189 solid nodules.Apart from 34 p-GGO lesions,among the other 236 cases,≤ 1 cm lesions were in 22 cases,1 cm-≤2 cm lesions in 138 cases,and ＞ 2 cm-≤3 cm lesions in 76 cases based on radiologic findings.The pathological types included adenocarcinoma （n =245）,squamous cell carci事oma （n =18）and other rare types （n =7）.The overall lymph node metastasis rate was 18.9％ （51/270）,and the incidence of lymph node involvement was 0 （0/34） in cancers with p-GGO,2.1％ （1/47） in mixed solid nodules,26.5％ （50/189） in solid nodules,18.2％ （4/22） in nodules ≤1 cm,14.5％ （20/138） in 1 cm ＜ nodules≤2 cm,and 35.5％ （27/76） in 2 cm ＜ nodules≤3 cm.The metastasis rates of non-specific tumor-draining region lymph nodes detected in the patients with positive and negative lobe-specific lymph node involvement were 20.0％-50.0％ vs.0-2.9％ （P ＜ 0.

关 键 词：癌 非小细胞肺 肿瘤分期 肿瘤转移 淋巴结切除术 

分 类 号：R734.2[医药卫生—肿瘤]