淋巴结转移特征对pN1期非小细胞肺癌术后局部转移的影响  

Effect of lymph node metastasis characteristics on local regional recurrence in stage pN1 non-small cell lung cancer

作　　者：杨剑逸 杨欣[1] 周之伟 马则铭 王嘉[1] 杨跃[1] Yang Jianyi;YangXin;Zhou Zhiwei;Ma Zeming;Wang Jia;Yang Yue(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Department of Thoracic SurgeryⅡ,Peking University School of Oncology,Beijing Cancer Hospital and Institute,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,北京100142

出　　处：《中华临床医师杂志（电子版）》2022年第5期385-390,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨pN1期非小细胞肺癌术后局部转移的高危因素,寻找术后辅助放疗的潜在获益者。方法入组2009年11月至2016年12月在北京大学肿瘤医院胸外二科接受肺癌根治手术的pN1期非小细胞肺癌患者。收集患者临床、病理及随访资料,采用单因素分析与多因素分析的方法,探究淋巴结被膜外侵犯、淋巴结转移度、多站转移、转移淋巴结位置分布等淋巴结转移特征对于局部区域复发的影响,主要研究终点为无局部复发生存。结果共纳入257例患者,其中男性159例,女性98例,年龄(58.5±8.5)岁(35~80岁)。中位随访时间58个月(5~131个月)。全部患者中,1、3、5年总生存率分别为97.7%、77.1%、70.1%;1、3、5年无复发生存率分别为79.3%、55.6%、45.3%;1、3、5年无局部复发生存率分别为88.2%、76.0%、69.7%;1、3、5年无远处转移生存率分别为84.4%、58.9%、48.7%。多因素分析显示,淋巴结被膜外侵犯(HR=1.96,95%CI:1.09~3.51,P=0.024)与淋巴结转移度>0.1(HR 2.28,95%CI:1.03~5.07,P=0.043)是术后局部复发的独立危险因素。结论淋巴结被膜外侵犯与淋巴结转移度>0.1的pN1期非小细胞肺癌是术后局部区域复发的高危人群,其有可能成为术后辅助放疗的潜在获益者。Objective To explore therisk factors forlocoregional recurrence in stage pN1non-small cell lung cancer patients,and identify potential candidates for adjuvant radiotherapy.Methods Patients diagnosed with stage pN1 non-small cell lung cancer who received radical surgery atBeijing Cancer Hospital between November 2009 and December 2016 were enrolled.The clinical,pathological,and surveillancedata of the patients were collected.The primary endpoint was locoreginal recurrence free survival(LRFS).Lymph node characteristics including extracapsular extension,lymph node ratio,multistation metastasis,distribution of metastaticlymph nodes,etc.were analysed by univariate and multivariate analyses.Results A total of 257 patients were enrolled,among whom 159 were male and 98 were female.The median age was(58.5±8.5)years(range:35~80 years).The median follow-up time was 58months(range:5~131 months).The 5-year LRFS rate for the entire cohort was 69.7%.Multivariate analysis demonstratedthat extracapsular extension(HR=1.96,95%CI:1.09~3.51,P=0.024)and lymph node ratio>0.1(HR=2.28,95%CI:1.03~5.07,P=0.043)were significantly correlated with lower LRFS.Conclusion Extracapsular extension and lymph node ratio>0.1 are risk factors for locoregional recurrence in stage pN1non-small cell lung cancer.Patients carrying those risk factors might potentially benefit from adjuvant radiotherapy.

关 键 词：癌 非小细胞肺 局部区域复发 淋巴结被膜外侵犯 淋巴结转移度 

分 类 号：R734.2[医药卫生—肿瘤]