Incidence and Distribution of Lobe-Specific Mediastinal Lymph Node Metastasis in Non-small Cell Lung Cancer: Data from 4511 Resected Cases
Incidence and Distribution of Lobe-Specific Mediastinal Lymph Node Metastasis in Non-small Cell Lung Cancer: Data from 4511 Resected Cases
复制标题
非小细胞肺癌肺叶特异性纵隔淋巴结转移的发生率和分布：来自 4511 例切除病例的数据
DOI：
10.1245/s10434-018-6394-9
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发表时间：
2018-10-01
影响因子：
3.7
通讯作者：
Yang, Hao-Xian
中科院分区：
文献类型：
--
作者：
Liang, Run-Bin;Yang, Jie;Yang, Hao-Xian
目的探讨可手术非小细胞肺癌(NSCLC)纵隔淋巴结转移(MLNM)的发生率和分布，以指导纵隔淋巴清扫术(MLND)。这些患者在手术前没有接受治疗，并根据原发肿瘤叶进行分组。结果1784例(39.5%)患者有淋巴结转移。共有628例(13.9%)仅N1阳性，752例(16.7%)N1和N2同时阳性，404例(9.0%)仅N2阳性。不同原发灶最常见的纵隔转移部位分别为右上叶4R站(21.5%，192/893)、右中叶7站(21.1%，69/327)、右下叶7站(24.1%，212/878)、左上叶5站(22.2%，224/1008)和左下叶7站(21.7%，136/628)。然而，当只考虑N2例时，每个纵隔淋巴结区都可以有很高比例的转移(<5%)。多因素分析显示，细胞分化差、腺癌、肿瘤体积较大、中央型、年龄较小是MLNM的独立危险因素。结论不同的原发肿瘤部位发生MLNM的倾向不同，但一旦发生MLNM，各部位均可累及，不可忽视。系统性MLND是可手术非小细胞肺癌的首选术式。
ObjectiveWe aimed to investigate the incidence and distribution of mediastinal lymph node metastases (MLNM) in operable non-small cell lung cancer (NSCLC) with the purpose of guiding mediastinal lymph node dissection (MLND).MethodsA total of 4511 NSCLC patients who underwent resection between January 2001 and December 2014 were included. These patients were preoperatively untreated and grouped according to the primary tumor lobes. The incidence and distribution of pathologic MLNM were compared among groups, and multivariate analysis was conducted to find the independent factors impacting MLNM.ResultsLymph node involvement was observed in 1784 patients (39.5%). A total of 628 cases (13.9%) were N1-positive only, 752 cases (16.7%) were both N1- and N2-positive, and 404 cases (9.0%) were N2-positive only. The most common sites of mediastinal metastasis for different primary tumor lobes were the right upper lobe, station 4R (21.5%, 192/893); right middle lobe, station 7 (21.1%, 69/327); right lower lobe, station 7 (24.1%, 212/878); left upper lobe, station 5 (22.2%, 224/1008); and left lower lobe, station 7 (21.7%, 136/628). However, when only N2 cases were considered, each mediastinal lymph node zone can be involved with metastasis to a high proportion (> 5%). Multivariable analyses showed that poor cell differentiation, adenocarcinoma, larger tumor size, central type, and younger age were independent factors favoring MLNM.ConclusionsDifferent primary tumor locations have a different propensity to be sites of MLNM; however, once MLNM occurs, each zone can be involved and should not be neglected. Systematic MLND is the preferred procedure for operable NSCLC.