Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer.
Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer.
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DOI：
10.1016/j.athoracsur.2016.03.096
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Osarogiagbon RU
中科院分区：
文献类型：
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作者：
Smeltzer MP;Faris N;Yu X;Ramirez RA;Ramirez LE;Wang CG;Adair C;Berry A;Osarogiagbon RU
病理淋巴结分期是手术切除肺癌患者的关键预后因素。我们先前描述了在田纳西州孟菲斯市的一些机构接受治疗的一组患者中肺内淋巴结转移漏诊的程度。通过长期随访，我们现在对漏诊淋巴结转移对生存的影响进行量化。
我们进行了一项前瞻性队列研究，以评估肺癌患者再次解剖的剩余肺切除标本中无意丢弃的淋巴结。对获取的材料进行组织学检查，并将其分类为有转移和无转移的淋巴结。生存信息从医院癌症登记处获取。我们使用卡普兰 - 迈耶方法绘制生存分布，并使用控制重要人口统计学和临床因素的比例风险模型对其进行评估。
该研究包括110名患者，其中54%为女性，69%为白人。在25名（23%）患者中发现了有转移的丢弃淋巴结。与无淋巴结转移漏诊的患者相比，有淋巴结转移漏诊的患者死亡风险增加，未调整的风险比为2.0（p值 = 0.06），调整后的风险比为1.4（p值 = 0.45）。有>2个有转移的漏诊淋巴结的患者与无淋巴结转移漏诊的患者相比，死亡风险是其4.8倍（p值 = 0.0005）（调整后的风险比 = 6.5，p值 = 0.0001）。
肺癌切除标本中无意丢弃的肺内淋巴结发生转移与生存率降低有关。对肺癌切除标本采用更严格的大体解剖方案可能会提供有预后价值的信息。
Pathologic nodal stage is a key prognostic factor for patients with surgically resected lung cancer. We previously described the extent of missed intrapulmonary nodal metastasis in a cohort of patients treated at metropolitan Memphis, TN institutions. With long-term follow-up, we now quantify the survival impact of missed nodal metastasis. We conducted a prospective cohort study to evaluate inadvertently discarded lymph nodes in re-dissected remnant lung resection specimens from lung cancer patients. Retrieved material was histologically examined and classified as lymph nodes with and without metastasis. Survival information was obtained from hospital cancer registries. We plotted survival distributions using the Kaplan Meier method and evaluated them with proportional hazards models controlling for significant demographic and clinical factors. The study included 110 patients who were 54% female and 69% Caucasian. Discarded lymph nodes with metastasis were found in 25 (23%) patients. Patients with missed lymph node metastasis had an increased risk of death with an unadjusted hazard ratio of 2.0 (p-value= 0.06) and an adjusted hazard ratio of 1.4 (p-value=0.45) compared with those without missed lymph node metastasis. Patients with >2 missed lymph nodes with metastasis had 4.8 (p-value=0.0005) times the hazard of death compared to patients without missed lymph node metastasis (adjusted hazard ratio =6.5, p-value=0.0001). Metastasis to inadvertently discarded intrapulmonary lymph nodes from lung cancer resection specimens was associated with reduced survival. A more rigorous gross dissection protocol for lung cancer resection specimens may provide prognostically useful information.