临床T1a期非小细胞肺癌淋巴结转移相关因素分析  

Correlation factors of lymph node metastasis in patients with clinical stage Tla non-small cell lung cancer

作　　者：臧若川 高树庚[1] 赫捷[1] 毛友生[1] 薛奇[1] 王大力[1] 牟巨伟[1] 赵峻[1] 王永岗[1] 刘向阳[1] 谭锋维[1] 赵格非[1] 张倩[1] 张默言[1] 宋朋[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院胸外科,100021

出　　处：《中华肿瘤杂志》2015年第4期297-300,共4页Chinese Journal of Oncology

摘　　要：目的探讨直径≤2cm的临床T1a期非小细胞肺癌（NSCLC）患者的临床病理特征与淋巴结转移的关系。方法回顾性分析行肺叶切除术及系统性淋巴结清扫术、直径≤2cm的418例NSCLC患者的临床资料，采用Logisitc多因素回归分析影响淋巴结转移的独立因素。结果418例NSCLC患者中，经病理证实发生淋巴结转移25例。122例磨玻璃样病变患者均未发生淋巴结转移。行隆突下淋巴结清扫者399例，隆突下淋巴结转移7例。单因素分析结果显示，性别、吸烟史、淋巴结直径、磨玻璃样病变、分化程度和病变位置均与淋巴结转移有关（均P〈0．05）。多因素分析结果显示，淋巴结直径、分化程度和病变位置是影响NSCLC淋巴结转移的独立因素（均P〈0．05）。结论左肺病变、病理分化程度低、术前CT示淋巴结直径≥1em是影响NSCLC淋巴结转移的独立危险因素，术前应予重视且术中应行系统性淋巴结清扫；病理分化程度低、术前CT示淋巴结直径≥1cm的患者，发生隆突下淋巴结转移概率较高，推荐行该区淋巴结清扫；对于直径≤2cm磨玻璃样病变的患者，因极少发生淋巴结转移，推荐行选择性淋巴结清扫术。Objective To explore the relationship between the lymph node metastasis and elinicopathologieal features in patients with clinical stage Tla non-small cell lung cancer （NSCLC）. Methods Clinicopathological data of a total of 418 patients who underwent lobeetomy and systematic lymph node dissection were retrospectively analyzed. Logistic regression was used to analyze the relationship between lymph node metastasis and elinicopathological features. Results Lymph node metastasis was observed in 25 patients. There were 122 patients who were diagnosed as ground glass opacity with no lymph node metastasis. 399 patients had subcarinal dissection, among them 7 patients were found to have lymph node metastasis. Univariate analysis showed that gender, smoking history, diameter of lymph node, ground glass opacity （ GGO ）, differentiation of the tumor and tumor site were the factors affecting lymph node metastasis （all P〈0.05）. Logistic regression analysis showed that diameter of lymph node, differentiation of the tumor and the site of lesion were independent risk factors for lymph node metastasis of NSCLC. Conclusions Tumor in the left lung, poor differentiation, and diameter of lymph nodes ≥ 1 cm on the preoperative CT image are independent risk factors for lymph node metastasis of NSCLC, hence we should pay attention before surgery and systematic lymph node dissection should be done. For patients with poor differentiation and lymph nodes ≥ 1 era, subearinal lymph nodes dissection is recommended for the sake of higher possibility of lymph node metastasis. For patients with ground glass opacity ≤ 2 cm, the lymph node metastasis is extremely rare, therefore, selective lymph node dissection is reconmmended.

关 键 词：癌 非小细胞肺 肿瘤分期 淋巴转移 

分 类 号：R734.2[医药卫生—肿瘤]