非小细胞肺癌患者N2组淋巴结转移相关因素分析和淋巴结清除范围选择
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摘要
目的分析非小细胞肺癌患者N2组淋巴结转移相关因素,探讨N2组淋巴结采样或清除的适宜人群。方法回顾性分析本院胸外科2014年7月至2016年5月期间110例非小细胞肺癌患者的临床资料,统计与淋巴结转移的可能相关因素并分析。结果单因素分析显示,肿瘤最长径> 2 cm(P=0. 016)、淋巴结显影(P=0. 021)、胸膜受累(P=0. 002)为N2组淋巴结转移相关因素,同时具有三个相关因素为N2组淋巴结转移独立相关因素。结论肿瘤最长径、淋巴结显影、胸膜受累为N2淋巴结转移相关因素,对于同时有3个相关因素患者,强烈建议行系统性淋巴结清除。
Objective To analyze the related factors of lymph node metastasis in N2 group of patients with non-small cell lung cancer,and found its meaning for lymph node dissection. Methods A retrospective analysis was made on 110 patients with non-small cell lung cancer from July 2014 to May 2016 in our thoracic surgery department. Potential related factors were collected,single factor analysis and variate analysis were carried out to find the relationship between N2 lymph node metastasis and potential related factors. Results Univariate analysis showed that the longest diameter of the tumor > 2 cm( P = 0. 016),lymph node imaging( P = 0. 021),pleural involvement( P = 0. 002) were related factors of lymph node metastasis in N2 group,and these three factors were independent related factors of lymph node metastasis in N2 group. Conclusions The longest diameter of the tumor,lymph node imaging and pleural involvement are related factors of N2 lymph node metastasis. Systematic lymph node dissection is strongly recommended for patients with three related factors at the same time.
Objective To analyze the related factors of lymph node metastasis in N2 group of patients with non-small cell lung cancer,and found its meaning for lymph node dissection. Methods A retrospective analysis was made on 110 patients with non-small cell lung cancer from July 2014 to May 2016 in our thoracic surgery department. Potential related factors were collected,single factor analysis and variate analysis were carried out to find the relationship between N2 lymph node metastasis and potential related factors. Results Univariate analysis showed that the longest diameter of the tumor > 2 cm( P = 0. 016),lymph node imaging( P = 0. 021),pleural involvement( P = 0. 002) were related factors of lymph node metastasis in N2 group,and these three factors were independent related factors of lymph node metastasis in N2 group. Conclusions The longest diameter of the tumor,lymph node imaging and pleural involvement are related factors of N2 lymph node metastasis. Systematic lymph node dissection is strongly recommended for patients with three related factors at the same time.
引文
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[15]王云.非小细胞肺癌患者淋巴转移与肿瘤体积的关系[J].中国基层医药,2015(19):2944-2946.
[16]孙英,贺子琮,贺林,等.通过增强CT评估肺癌患者纵隔转移淋巴结的分布及规律[J].现代肿瘤医学,2017,25(13):2136-2139. DOI:10. 3969/j. issn. 1672-4992. 2017. 13. 032.
[17]王娟,齐丽萍,李晓婷,等.探讨周围型非小细胞肺癌纵隔淋巴结转移相关CT表现[J].中国医学影像技术,2012,28(10):1839-1843.
[18]吴华伟,肖湘生,刘士远,等.周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素[J].中华放射学杂志,2001,35(10):731-735. DOI:10. 3760/j. issn:1005-1201. 2001. 10. 002.
[2] Fitzmaurice C,Dicker D,Pain A,et al. The Global Burden of Cancer 2013[J]. JAMA Oncol,2015,1(4):505-527. DOI:10.1001/jamaoncol. 2015. 0735.
[3]袁世立,赵昌学,周斌.不同淋巴结清扫方式对非小细胞肺癌术后生存期的影响[J].中国医师杂志,2017,19(5):779-780.DOI:10. 3760/cma. j. issn. 1008-1372. 2017. 05. 044.
[4]张真榕,冯宏响,甘继瑞,等.纵隔淋巴结清扫范围对早期非小细胞肺癌预后的影响[J].中日友好医院学报,2016,30(4):217-220,224,封2. DOI:10. 3969/j. issn. 1001-0025. 2016. 04. 005.
[5]邹家威,缪莹莹,刘红兵,等. 18F-FDG PET-CT对周围型肺腺癌淋巴结转移的相关性研究[J].医学研究生学报,2017,30(7):746-752. DOI:10. 16571/j. cnki. 1008-8199. 2017. 07. 014.
[6]张礼平,邓波,王如文,等. 18 F-FDG PET/CT对非小细胞肺癌淋巴结转移的诊断价值[J].局解手术学杂志,2016,25(3):184-187. DOI:10. 11659/jjssx. 10E015145.
[7]白璐,于楠,李艳,等.基于18F-脱氧葡萄糖PET-CT成像对非小细胞肺癌纵隔淋巴结转移识别的Meta分析[J].中华放射学杂志,2016,50(10):752-757. DOI:10. 3760/cma. j. issn.1005-1201. 2016. 10. 005.
[8]刘珊,蒋永新,陈芸,等.纳米碳示踪非小细胞肺癌淋巴结清除临床应用研究[J].中华肿瘤防治杂志,2015,22(17):1393-1396.
[9] Hung JJ,Yeh YC,Jeng WJ,et al. Factors predicting occult lymph node metastasis in completely resected lung adenocarcinoma of 3 cm or smaller[J]. Eur J Cardiothorac Surg,2016,50(2):329-336. DOI:10. 1093/ejcts/ezv485.
[10] Kong M,Jin J,Cai X,et al. Characteristics of lymph node metastasis in resected adenosquamous lung cancer[J]. Medicine(Baltimore),2017,96(48):e8870. DOI:10. 1097/MD. 0000000000008870.
[11]陈志军,竺王玉,柴振达,等.病理T1期孤立性非小细胞肺癌淋巴结转移特征及其影响因素[J].浙江医学,2017,39(4):284-287. DOI:10. 12056/j. issn. 1006-2785. 2017. 39. 4. 2016-1241.
[12]李道胜,班媛媛,叶红,等.非小细胞肺癌淋巴结转移规律的临床病理学特征分析[J].中华诊断学电子杂志,2016,4(4):249-252. DOI:10. 3877/cma. j. issn. 2095-655X. 2016. 04. 008.
[13]姜冠潮,李晓,张康,等.临床Ⅰ期非小细胞肺癌N1淋巴结转移的危险因素[J].中华胸心血管外科杂志,2015,31(3):161-163. DOI:10. 3760/cma. j. issn. 1001-4497. 2015. 03. 009.
[14]苏鸣岗,李芳兰,田蓉,等.非小细胞肺癌N2淋巴结转移的危险因素分析[J].中华核医学与分子影像杂志,2014,34(2):86-90. DOI:10. 3760/cma. j. issn. 2095-2848. 2014. 02. 002.
[15]王云.非小细胞肺癌患者淋巴转移与肿瘤体积的关系[J].中国基层医药,2015(19):2944-2946.
[16]孙英,贺子琮,贺林,等.通过增强CT评估肺癌患者纵隔转移淋巴结的分布及规律[J].现代肿瘤医学,2017,25(13):2136-2139. DOI:10. 3969/j. issn. 1672-4992. 2017. 13. 032.
[17]王娟,齐丽萍,李晓婷,等.探讨周围型非小细胞肺癌纵隔淋巴结转移相关CT表现[J].中国医学影像技术,2012,28(10):1839-1843.
[18]吴华伟,肖湘生,刘士远,等.周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素[J].中华放射学杂志,2001,35(10):731-735. DOI:10. 3760/j. issn:1005-1201. 2001. 10. 002.