文章摘要
葛鹏飞,赵 飞,周 悦,李 俊,孙云刚,孟阳春,黄陈军,王 伟.cTNM-Ⅰ期非小细胞肺癌肺叶特异性纵隔淋巴结转移规律的探讨[J].南京医科大学学报,2017,(6):714~718,736
cTNM-Ⅰ期非小细胞肺癌肺叶特异性纵隔淋巴结转移规律的探讨
Study of clinical indications of lobe-specific mediastinal lymph node dissection in patients with non-small-cell lung cancer of cTNM-Ⅰ stage
投稿时间:2016-08-08  
DOI:10.7655/NYDXBNS20170612
中文关键词: 非小细胞肺癌  纵隔淋巴结  转移
英文关键词: non-small-cell lung cancer  mediastinal lymph node  metastasis
基金项目:江苏省自然科学基金(BK20151589
作者单位
葛鹏飞 南京医科大学第一附属医院胸外科江苏 南京 210029 
赵 飞 南京医科大学第一附属医院胸外科江苏 南京 210029 
周 悦 南京医科大学第一附属医院胸外科江苏 南京 210029 
李 俊 南京医科大学第一附属医院胸外科江苏 南京 210029 
孙云刚 南京医科大学第一附属医院胸外科江苏 南京 210029 
孟阳春 南京医科大学第一附属医院胸外科江苏 南京 210029 
黄陈军 南京医科大学第一附属医院胸外科江苏 南京 210029 
王 伟 南京医科大学第一附属医院胸外科江苏 南京 210029 
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中文摘要:
      目的:目前对于早期非小细胞肺癌(non-small-cell lung cancer,NSCLC)纵隔淋巴结转移模式的研究尚少。本研究旨在了解这些患者的不同临床特征是否会引起肺叶特异性淋巴结转移率和非特异性纵隔淋巴结转移率的不同变化,从而推测在早期NSCLC患者中行单纯肺叶特异性淋巴结清扫的临床适应证。方法:调查了609例肺叶切除术和系统纵隔淋巴结清扫的cTNM-Ⅰ期的NSCLC患者。从临床资料包括肿瘤大小、肿瘤的组织学类型、性别和年龄等方面来分析肺叶特异性纵隔淋巴结转移率和非特异性纵隔淋巴结的转移率。结果:符合以下特点的Ⅰ期NSCLC患者的纵隔淋巴结转移大部分被限制在了肺叶特异性纵隔淋巴结:①男性,年龄>60岁,鳞状细胞癌,肿瘤最大径≤5 cm;②男性,年龄≤60岁,鳞状细胞癌,肿瘤最大径≤3 cm;③女性,鳞状细胞癌,肿瘤最大径≤3 cm;④腺癌,肿瘤最大径≤2 cm。结论:符合以上条件的术前cTNM-Ⅰ的NSCLC患者的纵隔淋巴结转移大部分局限于肺叶特异性淋巴结,对于这些患者,单纯清扫其肺叶特异性淋巴结是足够的;而其他患者出现肺叶非特异性纵隔淋巴结转移的风险将会明显升高,对于这类患者,系统的淋巴结清扫仍是最为有效的方法。
英文摘要:
      Objective: At present, there are few studies on the metastasis model of mediastinal lymph node (MLN) in stage I non-small-cell lung cancer (NSCLC). This study aimed to identify if patients with different clinical characteristics have different changes in metastatic rates between lobe-specific and non-specific MLN stations in patients with preoperative stage I NSCLC, so as to predict clinical indications of lobe-specific MLN dissection in patients with preoperative stage I NSCLC. Methods: We examined 609 patients with clinical stage I NSCLC for lobectomy with complete MLN dissection. We analyzed the metastatic rates of lobe-specific and other MLN stations with patient characteristics, including T stage, tumor histology, gender and age. Results: It was revealed that metastasis was limited to lobe-specific MLNs for stage Ⅰ patients meeting the following criteria: ①male, > 60 years, squamous cell tumor, and tumor≤5cm. ②male, ≤60 years, squamous cell tumor, and tumor≤ 3 cm. ③female, squamous cell tumor, and tumor≤3 cm. ④adenocarcinoma and tumor≤2 cm. Conclusion: Lobe-specific mediastinal lymph node MLN dissection is suitable for the patients with characteristics mentioned above. For other patients, there was a considerable increasing risk of metastasis, and complete MLN dissection remains the most effective method.
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