cTNM-ⅠA期非小细胞肺癌肺门淋巴结转移的规律及临床意义  

Exploration of the pattern of lung hilar lymph node metastasis in cTNM-stage ⅠA non-small cell lung cancer and its clinical significance

作　　者：高雄 唐震[1] 贡会源[1] 李伟[1] 张雷[1] 王彪[1] GAO Xiong;TANG Zhen;GONG Hui-yuan;LI Wei;ZHANG Lei;WANG Biao(Department of Thoracic Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院胸外科,安徽蚌埠233004

出　　处：《中华全科医学》2022年第8期1307-1310,共4页Chinese Journal of General Practice

基　　金：安徽省中央引导地方科技发展项目(2020b07030008)。

摘　　要：目的探讨肺门淋巴结(第10组淋巴结)在cTNM-ⅠA期非小细胞肺癌(NSCLC)中的转移规律以及临床意义。方法回顾性分析2020年1月1日—2021年1月1日蚌埠医学院第一附属医院胸外科收治的233例原发性cTNM-ⅠA期NSCLC患者在接受肺叶切除和系统性淋巴结清扫术后的肿瘤及淋巴结病理情况。结果233例患者共取得淋巴结3145枚,平均每例13.5枚,440枚淋巴结存在癌转移,转移率为14.0%。233例患者中49例有胸内淋巴结转移,其中N_(1)有16例,N_(1)+N_(2)有25例[注:N_(1)为单纯肺内淋巴结存在转移;N_(1)+N_(2)为存在N_(2)(纵隔2~9组淋巴结)转移的同时,亦存在N_(1)(肺内第10~14组淋巴结)],跳跃性N2有8例,总转移率为21.0%(49/233)。其中N_(1)中第10组淋巴结阳性的有10例,占62.5%(10/16),N1+N2中第10组淋巴结阳性的有18例,占72.0%(18/25)。第10组淋巴结转移率在T_(1b)期和T_(1a)期差异具有统计学意义(P<0.05),第10组淋巴结在低分化及中分化肺癌中的转移率分别为25.9%(21/81)和8.3%(7/84),差异有统计学意义(χ^(2)=9.060,P<0.05)。结论NSCLC中第10组淋巴结转移与原发肿瘤大小、临床病理类型、分化程度密切相关,在N_(1)、N_(1)+N_(2)、N_(2)存在淋巴结转移的情况下,第10组淋巴结阳性的概率较大;因此,早期非小细胞肺癌患者接受手术时优先对第10组淋巴结进行病理检测,根据第10组淋巴结病理情况,决定下一步手术方案更具有科学性。Objective To investigate the metastasis pattern of hilar lymph nodes(group 10 lymph nodes)in cTNM-ⅠA stage non-small cell lung cancer(NSCLC)and the clinical significance.Methods A retrospective analysis of tumor and lymph node pathology was performed in 233 patients with primary cTNM-stageⅠNSCLC,who underwent lobectomy and systemic lymph node dissection from January 1,2020 to January 1,2021 in the thoracic surgery ward of the First Affiliated Hospital of Bengbu Medical College.Results A total of 3145 lymph nodes were obtained from 233 patients,with an average of 13.5 lymph nodes per case,and 440 lymph nodes had cancer metastasis,with a metastasis rate of 14.0%.Among the 233 patients,49 cases had intrathoracic lymph node metastasis,including 16 cases of N 1,25 cases of N 1+N 2[Note:N 1:metastasis of intrapulmonary lymph nodes alone;N 1+N 2:metastasis of N 2(mediastinal group 2-9 lymph nodes)and N 1(intrapulmonary group 10-14 lymph nodes)at the same time]and 8 cases of skipping status N 2,with a total metastasis rate of 21.0%(49/233).Among them,10 cases were positive for group 10 lymph nodes in N 1,accounting for 62.5%(10/16),and 18 cases were positive for group 10 lymph nodes in N 1+N 2,accounting for 72.0%(18/25).The difference in metastasis rate of lymph nodes in group 10 was statistically significant between stage T 1b and stage T 1a(P<0.05),and the metastasis rates of lymph nodes in group 10 in poorly and moderately differentiated lung cancer were 25.9%(21/81)and 8.3%(7/84),respectively,the difference was statistically significant(χ^(2)=9.060,P<0.05).Conclusion In NSCLC,group 10 lymph node metastasis is closely related to the primary tumor size,clinicopathological type and differentiation degree.In the case of lymph node metastasis in N 1,N 1+N 2 and N 2,the possibility of positive lymph node in group 10 is higher.Therefore,pathological detection of group 10 lymph nodes is a priority when NSCLC patients need a surgical operation,and it is more scientific to decide the subsequent surgical plan,depending on

关 键 词：淋巴结转移 非小细胞肺癌 肿瘤 病理学 

分 类 号：R734.2[医药卫生—肿瘤]