Radical mediastinal nodal removal improves disease-free survival for pulmonary low-grade malignant tumors
Radical mediastinal nodal removal improves disease-free survival for pulmonary low-grade malignant tumors
复制标题
根治性纵隔淋巴结切除可提高肺部低度恶性肿瘤的无病生存率
DOI：
10.1016/j.lungcan.2011.07.016
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发表时间：
2012-03-01
期刊：
影响因子：
5.3
通讯作者：
Chen, Chang
中科院分区：
文献类型：
--
作者：
Zheng, Hui;Xie, Hui-kang;Chen, Chang
目的：探讨根治性淋巴结清扫术在治疗肺低度恶性肿瘤（LGMTs）的预后作用;特别是，对淋巴结切除的程度及其对长期survival.Methods的影响：共93例LGMTs进行手术切除，并经组织病理学证实。根据淋巴结切除范围和肿瘤组织病理学分级分别计算总生存率和无病生存率。通过多变量分析计算淋巴结受累的危险因素和生存预测因素。结果：38例类癌，17例腺样囊性癌，38例粘液表皮样癌均为非肿瘤性。高分级21例，低分级72例。共切除813个淋巴结，平均每例患者8.7 +/- 5.4个淋巴结。在研究组中，通过根治性淋巴结切除获得的淋巴结数量为11.8 +/- 4.5，在淋巴结取样组中，每例患者获得4.0 +/- 2.4个淋巴结。淋巴结转移11例（纵隔5例，肺门6例）。不同组织学类型（p = 0.939）或淋巴结切除程度（p = 0.971）之间的总生存率无显著差异。同时，根据淋巴结切除程度，无病生存率（DFS）存在显著差异（5-YS：97%的根治性淋巴结清扫vs. 78%的淋巴结取样，p = 0.038）。总生存率和无病生存率与组织学分级密切相关（OS：78%的高级别患者对97%的低级别患者，p= 0.001; DFS：57%的高级别患者对97%的低级别患者，p = 0.001）。
Purpose: To investigate the prognostic role of radical lymph node dissection in treatment for pulmonary Low Grade Malignant Tumors (LGMTs); specifically, on the extent of nodal removal and its impact on long-term survival.Methods:A total of 93 LGMTs cases underwent surgical resection and were histopathologically confirmed. Overall survival rates and disease-free survival were respectively calculated according to the extent of lymph node resection and histopathological grades of tumors. Risk factors of nodal involvement and survival predictors were calculated via multivariate analysis. Life table, Kaplan-Meier, and Cox regression models were used for the statistical analysis.Results: Thirty-eight cases of carcinoid, 17 adenoid cystic carcinomas, and 38 mucoepidermoid carcinomas were included in the current study. Twenty-one cases were high-grade and 72 were low-grade. A total of 813 lymph nodes were removed, at an average of 8.7 +/- 5.4 nodes per patient. The numbers of harvested nodes were 11.8 +/- 4.5, in the study group via radical nodal removal and 4.0 +/- 2.4 nodes per patient in the nodal sampling group. Eleven cases showed lymph nodal involvement (5 mediastinal and 6 hilar lymph node metastasis). No significant differences of overall survival was found among the different histological types (p = 0.939), or the extent of nodal removal (p = 0.971). Meanwhile, there was a significant difference of disease-free survival (DFS) rates according to the extent of nodal removal (5-YS: 97% of radical nodal dissection vs. 78% of nodal sampling, p = 0.038). Overall survival and disease-free survival were closely associated with histological grading (OS: 78% of high grade vs. 97% of low grade, p= 0.001: DFS: 57% of high grade vs. 97% of low grade, p