200例临床Ⅰa期非小细胞肺癌淋巴结转移因素研究  

Factors Related to Lymph Node Metastasis in Patients with Stage Ⅰa Non-small Cell Lung Cancer

作　　者：曾剑[1] 陈奇勋[1] 骆涛波 郑林峰[1] ZENG Jian;CHEN Qi-xun;LUO Tao-bo;ZHENG Lin-feng(Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院

出　　处：《中国肿瘤》2018年第9期715-720,共6页China Cancer

基　　金：2014年浙江省医药卫生一般研究计划(2014KYB044)

摘　　要：[目的]探讨不同临床及病理特征的临床Ⅰa期非小细胞肺癌淋巴结转移情况。[方法]自2014年7月至2016年7月,术前诊断为临床Ⅰa期非小细胞肺癌患者200例入组,所有患者接受病变所在肺叶切除加系统性淋巴结清扫。分析其临床特征、病理类型与术后淋巴结转移情况的关系。[结果]随着肿瘤直径的增大,N1淋巴结转移、N2淋巴结转移率均增高。术前CT表现为纯磨玻璃结节、实性成分〈50%、实性成分≥50%的患者N1淋巴结转移分为为0、2.82%和9.52%,N2淋巴结转移分别为0、4.23%和25.40%,差异有统计学意义（P=0.000）。病理类型为鳞癌者淋巴结转移率高于腺癌,主要是N1淋巴结转移率较高（P〈0.05）。病变位置位于近肺门内1/2的患者淋巴结转移率显著高于外1/2的患者（P=0.018）。多元回归分析显示,与淋巴结转移相关的因素为：肿瘤大小、影像学实性成分占比、与肺门相对位置。[结论]影像学表现为纯毛玻璃结节、肿瘤位于外肺门1/2、肿瘤小于1cm等特征的临床Ⅰa期非小细胞肺癌不易发生淋巴结转移,可酌情减少淋巴结清扫范围以减少创伤。[Purpose] To explore the factors related to lymph node metastasis in patients with stageⅠa non-small cell lung cancer（NSCLC）. [Methods] Two hundred patients with stage Ⅰa NSCLC admitted from July 2014 to July 2016 were enrolled in the study. All of the patients underwent lobectomy and systematic lymph node dissection. The correlation of clinicopathological features with lymph node metastasis was analyzed. [Results] The N1 and N2 lymph node metastases were increased with the increasing of tumor diameter. There were significant differences in N1 lymph node metastasis（0,2.82% and 9.52%） and N2 lymph node metastasis（0,4.23% and 25.40%） among patients with ground glass opacity（GGO） nodules,with nodules of solid components 〈50% and ≥50%on preoperative CT imaging（P=0.000）. The rate of N1 lymph node metastasis in squamous cell carcinoma was higher than that in adenocarcinoma（P〈 0.05）. The rate of lymph node metastasis in patients with lesion located within 1/2 lung field to hilum was significantly higher than that in patients with beyond 1/2（P=0.018）. Multiple regression analysis showed that tumor diameter,proportion of solid components in CT imaging,relative location of tumor to hilum of the lung were influencing factors for lymph node metastasis. [Conclusion] It is suggest that for stage Ⅰa NSCLC patients with pure GGO nodules,lesion location beyond 1/2 lung field to hilum and lesions〈 1 cm,the range of lymph node dissection could be reduced.

关 键 词：非小细胞肺癌 淋巴结转移 临床病理学 

分 类 号：R734.2[医药卫生—肿瘤]