非小细胞肺癌纵隔淋巴结跳跃性转移的研究

目的 探讨非小细胞肺癌（NSCLC）纵隔淋巴结跳跃性与非跳跃性与非跳跃性转移的临床特点及预后的差异。方法 以1982-1994年间我院行手术治疗的176例ⅢA期有纵隔淋巴结转移的NSCLC患者为研究对象，其中53例不伴有肺门淋巴结转移，称为跳跃组；123例伴有肺门淋巴结转移，称为非跳跃组，将纵隔淋巴结分为3个区域，分析两组患者淋巴结转移范围及其与生存率的关系。结果 在跳跃组中，有49例（92.5%)纵隔淋巴结转移局限于1个区域（L1），而在非跳跃组中有45例（36.6%)，纵隔淋巴结转移扩至2或3个区域L2或L3），跳跃组的5年生存率为29.3%，高于非跳跃组（12.2%,P=0.038)，且在同一L1上，跳跃组5年生存率（32.1%)亦高于非跳跃组（15.3%,P=0.042)。结论 NSCLC患者纵隔淋巴结跳跃性转移为纵隔淋巴结转移病变中独特的一个亚群。

Skip metastasis to the mediastinal lymph nodes in non-small cell lung cancer

OBJECTIVE: To ascertain if any difference exists in clinical characteristics between resected non-small cell lung cancer (NSCLC) with either skip or ordinary mediastinal lymph node metastases. METHODS: Among 176 patients with stage IIIAN2 disease between 1982-1994 treated in our hospital, 53 had no metastasis at the hilar lymph nodes [skip(+) group] while 123 had [skip(-) group]. To investigate the extent of nodal involvement, the mediastinal lymph nodes were divided into three regions. RESULTS: In the skip(+) group, mediastinal node metastasis was found in only one region in 49 of the 53 patients(92.4%), whereas 45 of the 123 patients(36.6%) from the skip (-) group revealed medinastinal metastasis at two or three regions The overall survival rate at 5 years after operation was 29.3% in the skip(+) group and 12.2% in the skip (-) group (P = 0.038). Furthermore, regarding patients with mediactint node metantion in one region, the skip(+) group had a better prognosis than the skip (-) group (32.1% vs 15.3%, P = 0.042). CONCLUSION: These results suggest that patients with skip mediastinal lymph node metastases represent a unique subgroup of N2 disease.