N1期非小细胞肺癌患者肺内转移淋巴结解剖部位与疾病复发风险及预后的关系分析  

Analysis of the relationship between the anatomical location of intrapulmonary metastatic lymph nodes and relapse risk and survival in patients with N1 non-small cell lung cancer

作　　者：赵大川 阎石[1] 王亚旗[1] 马媛媛 王兴[1] 李少雷[1] 李想[1] 吕超[1] 王宇昭[1] 王嘉[1] 杨跃[1] 吴楠[1] Zhao Dachuan;Yan Shi;Wang Yaqi;Ma Yuanyuan;Wang Xing;Li Shaolei;Li Xiang;Lyu Chao;Wang Yuzhao;Wang Jia;Yang Yue;Wu Nan(Department of Thoracic SurgeryⅡ,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research Ministry of Education/Beijing,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胸外二科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华医学杂志》2021年第35期2778-2786,共9页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC0910700);北京市优秀人才培养资助项目(2017000021469G235)。

摘　　要：目的:探讨N1期非小细胞肺癌(NSCLC)患者肺内转移淋巴结解剖部位与疾病复发风险及预后的关系。方法:回顾性分析2007年1月至2015年12月就诊于北京大学肿瘤医院胸外二科并接受根治性手术治疗的138例N1期NSCLC患者资料,男79例,女59例,年龄26~81(59±10)岁。分别依据以肺内淋巴结的解剖部位定义的改良N1分期方案及美国癌症联合会(AJCC)第八版肺癌N1站淋巴结分期方案进行分期,其中改良N1站淋巴结分期分为肺门组(第10、11组,mN1b)(36例)及肺内组(第12~14组,mN1a)(102例)。采用Kaplan-Meier法比较复发风险及生存分析,并通过单因素及多因素分析的方法比较两种分期方法在无病生存期(DFS)及总生存期(OS)的差异,评估两者对具有不同疾病复发和生存风险的患者进行分期的有效性。结果:根据改良N1站淋巴结分期,其亚组间(mN1a组比mN1b组)5年DFS及OS差异均有统计学意义(59.5%比35.7%、81.2%比56.0%,均P<0.05),而根据AJCC第八版肺癌N1站淋巴结分期方案,其亚组间DFS及OS差异均无统计学意义(均P>0.05)。多因素分期提示改良N1分期对于DFS(HR=1.814,95%CI:1.005~3.275)及OS(HR=3.919,95%CI:1.918~8.009)均为独立预后因素(均P<0.05)。多因素分析提示第八版肺癌N1站淋巴结分期方案并非DFS(HR=1.360,95%CI:0.767~2.412)及OS(HR=1.620,95%CI:0.839~3.131)的独立预后因素(均P>0.05)。结论:依据N1期NSCLC患者肺内转移淋巴结的解剖部位定义的改良N1站淋巴结分期方案可以有效预测疾病复发风险及预后,且优于AJCC第八版N1站淋巴结分期方案。Objective To evaluate the relationship between the anatomical location of intrapulmonary metastatic lymph nodes and relapse risk and survival in patients with N1 non-small cell lung cancer(NSCLC).Methods A retrospective analysis of the clinical and pathological data of 138 patients with completely resected N1 NSCLC was conducted.There were 79 males and 59 females,aged from^(2)6 to 81 years with an average of(59±10)years.All of them were treated in the Department of Thoracic SurgeryⅡof Peking University Cancer Hospital between January 2007 and December 2015.Patients were stratified based on the 8th edition of the American Joint Committee on Cancer(AJCC)N1 classification and the modified pathological N1 classification strategy,respectively.According to modified pathological N1 classification strategy,which was defined based on the anatomical location of intrapulmonary metastatic lymph nodes,N1 nodes were subcategorized into the hilar(stations 10-11,mN1b)(n=36)and peripheral(stations 12-14,mN1a)(n=102)zones.The Kaplan-Meier curves were plotted to compare the relapse risk and survival analysis,disease-free survival(DFS),and overall survival(OS)were compared between the two staging methods through univariate and multivariate analysis to evaluate the effectiveness of the two classifications in stratifying patients with distinct risks of disease relapse and survival.Results According to the modified N1 classification,the differences in 5-year DFS and OS between the subgroups(mN1a vs mN1b)were statistically significant(59.5%vs 35.7%;81.2%vs 56.0%;both P<0.05).However,following the 8th edition of the AJCC N1 classification,no significant differences were found in DFS and OS between the subgroups(both P>0.05).Multivariate analysis showed that the modified N1 classification was an independent prognostic factor to DFS(HR=1.814,95%CI:1.005-3.275)and OS(HR=3.919,95%CI:1.918-8.009)(all P<0.05).However,the 8th edition of the AJCC N1 classification was not an independent prognostic factor to DFS(HR=1.360,95%CI:0.767-2.412)or O

关 键 词：癌 非小细胞肺 病理学N1 TNM分期 改良N1分期 

分 类 号：R734.2[医药卫生—肿瘤]