临床Ⅰ期非小细胞肺癌N1淋巴结转移的危险因素  

Risk factors of N1 lymph node metastasis in clinical stage Ⅰ non-small cell lung cancer

作　　者：姜冠潮[1] 李晓 张康[2] 施瑞卿 李剑锋[1] 李运[1] 刘军[1] 王俊[1] 

机构地区：[1]北京大学人民医院胸外科,100044 [2]济宁市第一人民医院胸外科

出　　处：《中华胸心血管外科杂志》2015年第3期161-163,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结临床Ⅰ期非小细胞肺癌（NSCLC）患者病例,分析肺内（N1）淋巴结转移的危险因素,以提高术前N分期的准确性,指导手术方式及治疗策略的制定.方法 回顾性分析2006年9月至2013年12月手术治疗的612例NSCLC患者的临床资料.通过单因素及多因素分析筛选出临床Ⅰ期NSCLC发生肺内淋巴结转移的独立危险因素.结果 术后病理为pN1者59例（9.6％,59/612）.单因素分析显示,男性、吸烟史、肿瘤直径、肿瘤位置（中央型）、病理类型（非腺癌）、肿瘤分化程度及肿瘤周边脉管微浸润为临床Ⅰ期NSCLC患者发生N1转移的危险因素.多因素分析显示肿瘤直径（OR=1.903,P＜0.01）、肿瘤分化程度（OR=2.591,P＜0.01）和脉管浸润（OR=6.170,P＜0.01）是临床Ⅰ期NSCLC患者发生N1转移的独立危险因素.对肿瘤直径进行ROC曲线分析,结果得出2 cm作为肿瘤直径的临界点,肿瘤直径≤2 cm时,N1转移率为4.9％;肿瘤直径＞2 cm时,N1转移率为15.0％（P=0.003）.结论 临床Ⅰ期NSCLC患者的肺内淋巴结转移率（pN1）为9.6％.肿瘤直径,肿瘤分化程度和脉管浸润为临床Ⅰ期NSCLC肺内淋巴结转移（PN1）的独立危险因素.直径＞2 cm的临床Ⅰ期NSCLC患者术前应考虑行PET-CT或者EBUS-TBNA等有创检查以明确N分期.Objective Identify risk factors of N1 lymph node metastasis in clinical stage l non-small cell lung cancer,to try to improve the accuracy of preoperative N staging and help make treatment decision.Methods Records of patients with clinical stage Ⅰ NSCLC who had undergone pulmonary resection with systematic node dissection at Peking University People＇ s Hospital between September 2006 and December 2013 were retrospectively reviewed.To identify risk factors for N1 node metastasis,univariate and multivariate logistic regression analyses were performed.Results Among the 612 patients eligible for this study,intrapulmonary lymph node（N1） metastasis occurred in 59 patients（9.6％）.In univariate analysis,7 risk factors were identified：male,cigarette smokers,tumor size,tumor location（central）,non-adenocarcinoma,tumor differentiation degree and microvascular invasion.In multivariate analysis,3 independent risk factors were identified：tumor size（OR =1.903,P ＜ 0.01）,tumor differentiation degree （OR =2.591,P ＜ 0.01） and microvascular invasion （OR =6.170,P ＜ 0.01）.Through the analysis of ROC curve,the optimal cutoff point of tumor size was 2 cm,the N1 transfer rate was 4.9％ when tumer size ≤2 cm,the rate was 15.0％ when tumer size ＞ 2 cm.Conclusion The prevalence of N1 nodal metastasis in clinical stage Ⅰ NSCLC patients was 9.6％.Tumor size,tumor differentiation degree and microvascular invasion were identified as 3 independent predictive risk factors for N1 nodal metastasis in clinical stage Ⅰ NSCLC patients.Patients of clinical stage Ⅰ NSCLC with tumor size ＞ 2 cm were recommended to receive further N staging procedures（PET/CT or EBUS-TBNA） before surgery to attain a more accurate N stage.

关 键 词：非小细胞肺癌 肺内淋巴结转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]