纵隔淋巴结清扫范围对早期非小细胞肺癌预后的影响  

Effect of mediastinal lymph node dissection on early stage non-small cell lung cancer

作　　者：张真榕[1] 冯宏响[1] 甘继瑞 肖飞[1] 郭永庆[1] 石彬[1] 宋之乙[1] 田燕雏[1] 梁朝阳[1] 刘德若[1] 

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《中日友好医院学报》2016年第4期217-220,224,F0002,共6页Journal of China-Japan Friendship Hospital

摘　　要：目的:评估不同纵隔淋巴结清扫方式对早期非小细胞肺癌预后的影响。方法:回顾性分析563例临床Ⅰ期非小细胞肺癌患者临床数据。结果:入组患者200例患者行叶特异性淋巴结清扫;363例患者行系统性淋巴结清扫。与系统性淋巴结清扫相比,叶特异性淋巴结清扫组清扫纵隔淋巴结个数较少(9.84±8.55 vs 13.09±9.31,P<0.01);发生多站N2淋巴结转移较少(15.8%vs 55.7%,P<0.01);局部复发率(12.0%vs 6.6%,P<0.05)和远处转移率(28%Vs 18.2%,P<0.01)较高;但多因素分析显示淋巴结清扫方式并不是局部复发率和远处转移率的独立风险因素(P>0.05);2组比较所有入组患者生存率和不同肿瘤大小生存率均无统计学差异。结论:叶特异性淋巴结清扫具有与系统性淋巴结清扫相一致的肿瘤治疗效果,可以在早期非小细胞肺癌范围内进行推广。Objective：To evaluate the effect of different mediastinal lymph node on non-small cell lung cancer.Methods：Clinical data of 563 clinical stage I pathologically confirmed non-small cell lung cancer were reviewed.Results：200 lobe specific lymph node dissection and 363 medianstinal lymph node dissection were performed.Compared with medianstinal lymph node dissection,fewer mediastinal lymph nodes were dissected（9.84±8.55 vs 13.09±9.31,P〈0.01）,fewer multiple mediastinal station metastasis cases were found（15.8% Vs55.7%,P〈0.01）.The local recurrence（12.0% vs 6.6%,P0.05）and distant metastasis（28% vs 18.2%,P0.01）ratio were much higher in lobe specific lymph node dissection group.While Cox regression didn＇t verify the way of lymph node dissection as significant risk factors of both local recurrence and metastasis.No difference was found in 5 year survival between the 2 groups.Subgroup analysis showed no difference of 5 year survival between the 2 groups for T1 a,T1b and T2a-b patients.Conclusion：For patients with clinical stage I non-small cell lung cancer,lobe specific lymph node dissection could get similar oncological efficacy compared with systemic mediastinal lymph node dissection.

关 键 词：非小细胞肺癌 叶特异性淋巴结清扫 系统性淋巴结清扫 预后 

分 类 号：R734.2[医药卫生—肿瘤]