Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer - Results of a prospective randomized trial
Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer - Results of a prospective randomized trial
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DOI：
10.1097/00000658-199801000-00020
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发表时间：
1998-01-01
影响因子：
9
通讯作者：
Thetter, O
中科院分区：
文献类型：
--
作者：
Izbicki, JR;Passlick, B;Thetter, O
目的评价淋巴清扫术治疗非小细胞肺癌(NSCLC)的疗效。虽然一些中心仅对可疑的淋巴结进行纵隔淋巴结采样(LS)，但另一些中心建议进行根治性、系统性的纵隔淋巴清扫(LA)以提高生存率和获得更好的分期。方法在一项对照、前瞻性、随机的临床试验中，分析了LA对复发率和生存率的影响，并比较了169例可手术NSCLC患者的LS和LA。结果中位随访47个月后，LA对整个组患者的生存率没有改善(风险比：0.78；95%可信区间：0.47-1.24)。虽然在接受LA的患者中复发率趋于降低，但这些降低在统计学上并不显著(风险比：0.82；95%可信区间：0.54-1.27)。然而，根据组织病理学淋巴结分期对患者亚组的分析显示，LA似乎延长了无复发生存期(p=0.037)，对有限淋巴结受累的患者(pn1病或pn2病仅累及一个淋巴结水平)的总生存率(p=0.058)有边缘影响；对于pno病患者，没有观察到生存益处。结论根治性系统性纵隔淋巴清扫不影响非小细胞肺癌患者的无病生存或总体生存。然而，一小部分纵隔淋巴结转移有限的患者可能从系统的淋巴清扫中受益。
Objective To evaluate the effectiveness of lymphadenectomy in the treatment of non-small cell lung cancer(NSCLC).Summary Background Data The extent of lymphadenectomy in the treatment of NSCLC is still a matter of controversy. Although some centers perform mediastinal lymph node sampling (LS) with resection of only suspicious lymph nodes, others recommend a radical, systematic mediastinal lymphadenectomy (LA) to improve survival and to achieve a better staging.Methods In a controlled, prospective, randomized clinical trial, the effects of LA on recurrence rates and survival were analyzed, comparing LS and LA in 169 patients with operable NSCLC.Results After a median follow-up of 47 months, LA did not improve survival in the overall group of patients (hazard ratio: 0.78; 95% confidence interval: 0.47-1.24). Although recurrences rates tended to be reduced among patients who underwent LA, these decreases were not statistically significant (hazard ratio: 0.82; 95% confidence interval: 0.54-1.27). However, analysis of subgroups of patients according to histopathologic lymph node staging revealed that LA appears to prolong relapse-free survival (p = 0.037) with a borderline effect on overall survival (p = 0.058) in patients with limited lymph node involvement (pN1 disease or pN2 disease with involvement of only one lymph node level); in patients with pNO disease, no survival benefit was observed.Conclusions Radical systematic mediastinal lymphadenectomy does not influence disease-free or overall survival in patients with NSCLC and without overt lymph node involvement. However, a small subgroup of patients with limited mediastinal lymph node metastases might benefit from a systematic lymphadenectomy.