Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung.
Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung.
复制标题
可切除肺癌患者纵隔镜检查中发现的阳性上纵隔淋巴结的意义。
DOI：
10.1016/s0022-5223(19)37318-0
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
J. Cooper
中科院分区：
文献类型：
--
作者：
F. Pearson;N. Delarue;R. Ilves;T. Todd;J. Cooper
纵隔淋巴结转移的可切除肺癌的预后尚不清楚。有12篇论文报道了这类病例的结果，5年生存率从0%到30%不等。在过去的17年里，在多伦多总医院，141名患者接受了开胸手术，这些患者可能是可手术的非燕麦细胞肺癌，并有纵隔淋巴结转移。第一组为纵隔镜检查阳性的79例。这是一组高度精选的可能可手术的肺癌患者，经纵隔镜检查发现有同侧上纵隔转移，并认为有可能进行根治性切除。这一亚组仅占我们推测可手术的肺癌患者的五分之一，在纵隔镜检查中定义为N2状态。79例患者的5年生存率为9%。根治性切除51例，5年生存率15%，姑息性切除无一例存活5年。第二组为纵隔镜检查阴性(开胸时确定为N_2状态)的62例。所有62名患者的纵隔镜检查均为阴性，只有在随后的开胸手术中才被确定为氮气状态。62例患者5年生存率为24%，其中根治性切除25例，姑息性切除22例，5年生存率分别为41%和14%。那些在纵隔镜检查中确诊为氮气状态的患者的存活率明显低于那些在随后的开胸手术中确诊为氮气状态的“阴性纵隔镜检查”患者。强调纵隔镜在选择可手术的N_2病灶中的应用。
The prognosis for resectable lung cancer with metastases in mediastinal nodes is not clear. There are 12 papers reporting results in such cases, and the 5 year survival figures range from 0% to 30%. During the past 17 years at Toronto General Hospital, 141 patients had a thoracotomy for presumably operable, non-oat cell lung cancer with metastases in mediastinal nodes. Group 1, those with “mediastinoscopy positive” nodes, comprised 79 cases. This is a highly selected subset of patients with presumably operable lung cancer who had ipsilateral superior mediastinal metastases identified by mediastinoscopy, and in whom a curative resection was deemed possible. This subset represents only one fifth of our patients with presumably operable lung cancer in whom N2 status is defined at mediastinoscopy. The actuarial 5 year survival rate for all 79 patients was 9%. The 5 year survival rate in 51 curative resections was 15%, and no patient having a palliative resection survived 5 years. Group 2, those with “mediastinoscopy negative” nodes (N2 status determined at thoracotomy) comprised 62 cases. All 62 patients had negative mediastinoscopy, and the N2 status was established only at subsequent thoracotomy. The actuarial 5 year survival rate was 24% for all 62 patients, 41% for the 25 curative resections and 14% for the 22 palliative resections. The survival rate is significantly worse in those patients whose N2 status is established at mediastinoscopy than in those patients with a “negative mediastinoscopy” in whom the N2 status is established at subsequent thoracotomy. The application of mediastinoscopy in the selection of operable N2 lesions is emphasized.