老年临床N_(0)期非小细胞肺癌患者术后N_(1-2)期淋巴结转移的危险因素分析  

Risk factors of postoperative N_(1-2)stage lymph node metastasis in elderly patients with clinical N_(0) stage non-small cell lung cancer

作　　者：孙嘉阳[1] 鲁志刚[1] 郭占林[1] 郭欣君 SUN Jia-yang;LU Zhi-gang;GUO Zhan-lin;GUO Xin-jun(Department of Thoracic Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia Autonomous Region O10059,China;Department of Thoracic Surgery,People's Hospital of Inner Mongolia Autonomous Region,Hohhot,Inner Mongolia Autonomous Region O10o10,China)

机构地区：[1]内蒙古医科大学附属医院胸外科,内蒙古自治区呼和浩特010059 [2]内蒙古自治区人民医院胸外科,内蒙古自治区呼和浩特010010

出　　处：《中华实用诊断与治疗杂志》2023年第2期129-132,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：内蒙古科技厅资助项目(NKB2021038)。

摘　　要：目的观察老年临床N0期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者行解剖性肺叶切除+系统性淋巴结清扫术后组织病理检查情况,探讨其术后组织病理检查为N_(1-2)期淋巴结转移的影响因素。方法220例老年临床N0期NSCLC患者均行解剖性肺叶切除+系统性淋巴结清扫术,根据术后组织病理检查结果分为N0期组192例和N_(1-2)期组28例,比较2组组织病理类型、肿瘤直径、肿瘤分化程度、脉管浸润情况及血清癌胚抗原水平等,采用多因素logistic回归分析老年临床N0期NSCLC患者术后组织病理检查为N_(1-2)期的影响因素。结果N_(1-2)期组腺癌(78.57%)、肿瘤直径1~2 cm(82.14%)、低中分化(82.14%)、有脉管浸润(71.43%)、血清癌胚抗原≥5μg/L(75.00%)比率均高于N0期组(38.54%、6.25%、4.69%、5.73%、4.17%)(P<0.05),体质量指数、吸烟史、肿瘤部位与N0期组比较差异均无统计学意义(P>0.05)。腺癌(OR=2.931,95%CI:1.809~4.025,P=0.017)、肿瘤直径1~2 cm(OR=2.894,95%CI:1.781~3.872,P=0.012)、低中分化(OR=2.732,95%CI:1.621~3.694,P=0.015)、有脉管浸润(OR=2.712,95%CI:1.594~3.586,P=0.011)、血清癌胚抗原≥5μg/L(OR=2.746,95%CI:1.633~3.621,P=0.008)是老年临床N0期NSCLC患者术后组织病理检查为N_(1-2)期的危险因素。结论腺癌、肿瘤直径1~2 cm、低中分化、有脉管浸润和血清癌胚抗原水平升高的老年临床N0期NSCLC患者术后组织病理检查为N_(1-2)期淋巴结转移的风险较大。Objective To observe the histopathological examination results after anatomical lobectomy+systemic lymphadenectomy in patients with clinical stage N0non-small cell lung cancer(NSCLC),and to investigate the influencing factors of histopathological N_(1-2)stage lymph node metastasis.Methods Totally 220elderly NSCLC patients with clinical N0stage underwent anatomical lobectomy+systemic lymphadenectomy,and were divided into N0stage group(n=192)and N_(1-2)stage group(n=28)according to the results of postoperative histopathological examination.The histopathological type,tumor diameter,tumor differentiation degree,vascular invasion,and carcinoembryonic antigen level were compared between two groups.Multivariate logistic regression analysis was done to evaluate the influencing factors of postoperative histopathological N_(1-2)stage lymph node metastasis in elderly patients with clinical N0stage NSCLC.Results The percentages of patients with adenocarcinoma,tumor diameter 1-2 cm,poorly moderate differentiation,vascular invasion,and serum carcinoembryonic antigen≥5μg/L were higher in N_(1-2)stage group(78.57%,82.14%,82.14%,71.43%,75.00%)than those in N0stage group(38.54%,6.25%,4.69%,5.73%,4.17%)(P<0.05),and there were no significant differences in the body mass index,smoking history and tumor site between two groups(P>0.05).Adenocarcinoma(OR=2.931,95%CI:1.809-4.025,P=0.017),tumor diameter1-2cm(OR=2.894,95%CI:1.781-3.872,P=0.012),poorly moderate differentiation(OR=2.732,95%CI:1.621-3.694,P=0.015),vascular invasion(OR=2.712,95%CI:1.594-3.586,P=0.011),and carcinoembryonic antigen≥5μg/L(OR=2.746,95%CI:1.633-3.621,P=0.008)were the risk factors of postoperative histopathological N_(1-2)stage lymph node metastasis in elderly patients with clinical stage N0NSCLC.Conclusion Adenocarcinoma,tumor diameter of 1-2 cm,poorly moderate differentiation,vascular invasion and elevated carcinoembryonic antigen level increase the risk of postoperative histopathological N_(1-2)stage lymph node metastasis in patients with clinical N0stage N

关 键 词：非小细胞肺癌 TNM分期 淋巴结转移 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]