Number of Lymph Nodes Harvested From a Mediastinal Lymphadenectomy Results of the Randomized, Prospective American College of Surgeons Oncology Group Z0030 Trial
Number of Lymph Nodes Harvested From a Mediastinal Lymphadenectomy Results of the Randomized, Prospective American College of Surgeons Oncology Group Z0030 Trial
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DOI：
10.1378/chest.10-0859
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发表时间：
2011-05-01
期刊：
影响因子：
9.6
通讯作者：
Putnam, Joe B., Jr.
中科院分区：
文献类型：
--
作者：
Darling, Gail E.;Allen, Mark S.;Putnam, Joe B., Jr.
背景：淋巴结状态是肺癌患者分期和生存的主要决定因素；然而，关于纵隔淋巴结切除术的预期收益的信息很少。方法：1999年7月至2004年2月，美国外科学会肿瘤组Z0030纵隔淋巴结取样与肺切除术中完全纵隔淋巴结切除术的前瞻性随机试验纳入了1,111例患者。我们分析了524例接受完全纵隔淋巴结清扫的患者的数据，以确定获得的淋巴结数量。结果：在系统取样后，从纵隔淋巴结切除术中收获的额外淋巴结中位数为18，右侧肿瘤的范围为1至72，左侧肿瘤的范围为18，范围为4至69。N2个淋巴结的中位数为右侧11个，左侧12个。在99%的患者中，至少有6个淋巴结从至少3个淋巴结站摘除，90%的患者至少有10个淋巴结从3个淋巴结站摘除。总体而言，21例（4%）患者发现隐匿性N2疾病。结论：虽然不同淋巴结的实际淋巴结数量存在很大差异，但完全纵隔淋巴结切除术可以在所有纵隔淋巴结中切除一个或多个淋巴结。适当的纵隔淋巴结切除术应包括右侧肿瘤的2R、4R、7、8和9站，左侧肿瘤的4L、5、6、7、8和9站。在这项研究中，99%的患者切除了6个或更多的淋巴结。
Background: Lymph node status is a major determinant of stage and survival in patients with lung cancer; however, little information is available about the expected yield of a mediastinal lymphadenectomy.Methods: The American College of Surgeons Oncology Group Z0030 prospective, randomized trial of mediastinal lymph node sampling vs complete mediastinal lymphadenectomy during pulmonary resection enrolled 1,111 patients from July 1999 to February 2004. Data from 524 patients who underwent complete mediastinal lymph node dissection were analyzed to determine the number of lymph nodes obtained.Results: The median number of additional lymph nodes harvested from a mediastinal lymphadenectomy following systematic sampling was 18 with a range of one to 72 for right-sided tumors, and 18 with a range of four to 69 for left-sided tumors. The median number of N2 nodes harvested was 11 on the right and 12 on the left. A median of at least six nodes was harvested from at least three stations in 99% of patients, and 90% of patients had at least 10 nodes harvested from three stations. Overall, 21 patients (4%) were found to have occult N2 disease.Conclusions: Although high variability exists in the actual number of lymph nodes obtained from various nodal stations, complete mediastinal lymphadenectomy removes one or more lymph nodes from all mediastinal stations. Adequate mediastinal lymphadenectomy should include stations 2R, 4R, 7, 8, and 9 for right-sided cancers and stations 4L, 5, 6, 7, 8, and 9 for left-sided cancers. Six or more nodes were resected in 99% of patients in this study.