Predictive Factors for Node Metastasis in Patients With Clinical Stage I Non-Small Cell Lung Cancer
Predictive Factors for Node Metastasis in Patients With Clinical Stage I Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2013.03.050
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发表时间：
2013-07-01
影响因子：
4.6
通讯作者：
Jheon, Sanghoon
中科院分区：
文献类型：
--
作者：
Cho, Sukki;Song, In Hag;Jheon, Sanghoon
背景。非小细胞肺癌（NSCLC）的准确临床分期对于制定治疗计划和评估微创手术的适用性至关重要。本研究的目的是评估临床I期非小细胞肺癌N1和N2淋巴结转移的预测因素。回顾性分析2003年至2011年间临床I期NSCLC患者行系统性淋巴结清扫或淋巴结取样肺切除术的记录。为了确定淋巴结转移的预测因素，进行了单因素和多因素logistic回归分析。在本研究的770例患者中，淋巴结转移的总体发生率为19.4%，其中N1淋巴结为11.3%，N2淋巴结为8.1%。N1淋巴结转移的预测因素包括男性、吸烟者、非腺癌、固体一致性、肿瘤中心位置、临床T分期、细胞角蛋白片段21-1水平、肿瘤大小、肿块最大标准化摄取值、毛玻璃混浊比例。腺癌、固体一致性、临床T分期、癌胚抗原水平、肿瘤大小和毛玻璃混浊比例被确定为N2淋巴结转移的预测因子。多因素分析表明，肿瘤大小和固体稠度是N1、N2淋巴结转移的独立预测值。在临床I期NSCLC患者中，有19.4%的患者出现了意外的淋巴结转移，肿瘤的大小和坚固一致性是临床I期NSCLC淋巴结转移的预测因素。术前分期应更彻底，以提高术前分期的准确性，特别是对于那些肿瘤体积较大、固体一致性强的患者。(C) 2013年由胸外科学会发布
Background. Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing a treatment plan and evaluating suitability for minimally invasive surgery. The aim of this study was to evaluate predictive factors for metastasis of N1 and N2 nodes in clinical stage I NSCLC.Methods. Records of patients with clinical stage I NSCLC who had undergone pulmonary resection with systematic node dissection or node sampling between 2003 and 2011 were retrospectively reviewed. To identify predictive factors for node metastasis, univariate and multivariate logistic regression analyses were performed.Results. Among the 770 patients in this study, the overall prevalence of node metastasis was 19.4%, which included 11.3% of N1 nodes and 8.1% of N2 nodes. Predictive factors for N1 node metastasis included male sex, current smoker, non-adenocarcinoma, solid consistency, centrally located tumor, clinical T stage, cytokeratin fragment 21-1 level, tumor size, maximum standardized uptake value of the mass, and ground-glass opacity proportion. Adenocarcinoma, solid consistency, clinical T stage, carcinoembryonic antigen level, tumor size, and ground-glass opacity proportion were identified as predictors for N2 node metastasis. Both tumor size and solid consistency were independent predictive values of N1 node and N2 node metastasis by multivariate analysis.Conclusions. Among the patients with clinical stage I NSCLC, 19.4% of the patients showed unexpected node metastasis, and large size and solid consistency of the tumor were predictive factors of node metastasis in clinical stage I NSCLC. Preoperative staging should be performed more thoroughly to increase the accuracy of preoperative staging, especially in those who have the larger size and solid consistency of the tumor. (C) 2013 by The Society of Thoracic Surgeons