肺癌淋巴结转移规律的临床分析

目的　探讨原发肺癌大小、病理类型、细胞分化程度、部位类型与淋巴结转移的关系。方法　对3 3 2例肺癌患者施行肺切除术及广泛肺门及纵隔淋巴结清扫术 ,分析淋巴结的转移规律。结果　清除淋巴结3 2 80个 ,N1 转移率 2 9.9%,N2 转移率 2 2 .4%。T1 、T2 、T3 患者淋巴结总转移率分别为 8.5 %、2 7.4%、61.2 %(P <0 .0 0 5 )。高分化鳞癌未发现淋巴结转移 ,中、低分化鳞癌淋巴结转移率分别为 16.8%、19.6%,后二者间差异无显著性 ;中、低分化腺癌淋巴结转移率分别为 2 7.5 %、71.6%(P <0 .0 0 5 )。中央型及周围型鳞癌总淋巴结转移率分别为 19.6%、11.7%(P <0 .0 0 5 ) ,N2 转移率分别为 10 .9%、2 .9%(P <0 .0 0 5 ) ;中央型及周围型腺癌总淋巴结转移率分别为 5 7.9%、2 4.0 %(P <0 .0 0 5 ) ,N2 转移率分别为 47.5 %、17.8%(P <0 .0 0 5 )。相同T状态、细胞分化程度、肿瘤部位下 ,腺癌淋巴结转移率均显著高于鳞癌 (P <0 .0 0 5 )。结论　肺癌的淋巴结转移与原发肿瘤大小、病理类型、细胞分化程度、肿瘤发生部位均有密切关系

Clinical study on the metastatic patterns of lymph node in lung cancer

Objective To investigate the relationship between the size of primary tumor, pathologic classification, cell differentiation or location of tumor and lymph node metastasis in lung cancer. Methods Three hundred and thirty two patients with lung cancer underwent pulmonectomy plus extensive dissection of hilar and mediastinal nodes. The law of lymph node metastasis was analyzed. Results A total of 3 280 lymph nodes were removed. Metastatic rates of N1 and N2 were 29.9% and 22.4% respectively. The total lymph node metastatic rates of T1, T2, and T3 diseases were 8.5%, 27.4% and 61.2% respectively ( P <0.005). No lymphatic metastasis was observed in well differentiated squamous cell carcinoma, however, the lymph node metastatic rates in moderate and poor differentiated squamous cell carcinoma were 16.8% and 19.6% respectively. The lymph node metastatic rates were 27.5% and 71.6% in moderate and poor differentiated adenocarcinoma respectively ( P <0.005). The total lymph node metastatic rates in central and peripheral squamous cell carcinoma were 19.6% and 11.7% respectively ( P <0.005), while in adenocarcinoma, the rates were 57.9% and 24.0% respectively ( P <0.005). The N2 metastatic rates in central and peripheral squamous cell carcinoma were 10.9% and 2.9% respectively ( P <0.005), while in adenocarcinoma, the rates were 47.5% and 17.8% respectively ( P < 0.005 ). Under the same T status, cell differentiation or location of tumor, the metastatic rate of adenocarcinoma was much higher than that of squamous cell carcinoma ( P < 0.005 ). Conclusion The frequency of lymph node metastasis significantly correlate with size of primary tumor, pathological classification, cell differentiation and location of tumor.