Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?
Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?
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DOI：
10.1016/j.ejcts.2004.12.035
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Thomas, P
中科院分区：
文献类型：
--
作者：
Doddoli, C;Aragon, A;Thomas, P
目的：评估在pI期非小细胞肺癌（NSCLC）患者中进行的淋巴结清扫范围的治疗效果。方法：我们分析了465例接受手术切除和某种形式的淋巴结取样的I期NSCLC患者的数据。淋巴结采样的中位数为10个，同侧纵隔淋巴结采样的中位数为2个。我们选择将采集10个或更多淋巴结并采集两个或更多同侧纵隔淋巴结的手术定义为淋巴结切除术，而不是在一个或两个标准都不满足时进行采样。研究了手术技术：淋巴结取样（LS; n=207）与淋巴结切除术（LA; n=258）对30天死亡率和总生存率的影响。结果：共检查淋巴结6244个，其中纵隔淋巴结4306个。LS后每例患者切除淋巴结的平均（+/- SD）数量为7 ± 6.1，LA后为18.6 ± 9.3（P=0.001）。LS后每例患者平均采集1 ± 0.90个纵隔淋巴结，LA后为2.7 ± 0.8个（P < 10（-6））。总体30天死亡率分别为2.4%和3.1%。在多变量分析中，LA被认为是一个有利的预测因素（危险风险：1.43; 95%置信区间：1.00-2.04; P=0.048），同时患者年龄较小，无血管浸润，肿瘤尺寸较小。结论：淋巴结清扫的重要性影响患者的预后，但不增加手术死亡率。最少评估10个淋巴结，两个纵隔站采样建议作为淋巴结清扫术质量的可能实用的标志。(c)2005 Elsevier B. V.保留所有权利。
Objective: To assess the therapeutic effect of the extent of lymph node dissection performed in patients with a stage pl non-small-cell lung cancer (NSCLC). Methods: We analysed data on 465 patients with stage I NSCLC who were treated with surgical resection and some form of lymph node sampling. The median number of lymph node sampled was 10 and the median number of ipsilateral mediastinal lymph node stations sampled was two. We chose to define a procedure that harvested 10 or more lymph nodes and sampled two or more ipsilateral mediastinal stations as a lymphadenectomy, by contrast with sampling when one or both criteria were not satisfied. The effect of the surgical techniques: lymph node sampling (LS; n=207) vs. lymphadenectomy (LA; n=258) on 30-day mortality and overall survival were investigated. Results: A total of 6244 lymph nodes was examined, including 4306 mediastinal lymph nodes. The mean (+/- SD) numbers of removed lymph nodes were 7 +/- 6.1 per patient following LS vs.18.6 +/- 9.3 following LA (P=0.001). An average mean of 1 +/- 0.90 mediastinal lymph node station per patient was sampled following LS vs. 2.7 +/- 0.8 following LA (P < 10(-6)). Overall 30-day mortality rates were 2.4 and 3.1%, respectively. LA was disclosed as a favourable prognosticator at multivariate analysis (Hazard Risk: 1.43; 95% Confidence Interval: 1.00-2.04; P=0.048), together with younger patient age, absence of blood vessels invasion, and smaller tumour size. Conclusions: Importance of lymph node dissection affects patients outcome, while it does not enhance the operative mortality. A minimum of 10 lymph nodes assessed, and two mediastinal stations sampled are suggested as possible pragmatic markers of the quality of lymphadenectomy. (c) 2005 Elsevier B.V. All rights reserved.