cTNM-ⅠA期非小细胞肺癌肺门淋巴结转移的规律及临床意义

  目的  探讨肺门淋巴结(第10组淋巴结)在cTNM-ⅠA期非小细胞肺癌(NSCLC)中的转移规律以及临床意义。  方法  回顾性分析2020年1月1日—2021年1月1日蚌埠医学院第一附属医院胸外科收治的233例原发性cTNM-ⅠA期NSCLC患者在接受肺叶切除和系统性淋巴结清扫术后的肿瘤及淋巴结病理情况。  结果  233例患者共取得淋巴结3 145枚，平均每例13.5枚，440枚淋巴结存在癌转移，转移率为14.0%。233例患者中49例有胸内淋巴结转移，其中N₁有16例，N₁+N₂有25例[注:N₁为单纯肺内淋巴结存在转移；N₁+N₂为存在N₂(纵隔2~9组淋巴结)转移的同时，亦存在N₁(肺内第10~14组淋巴结)]，跳跃性N₂有8例，总转移率为21.0%(49/233)。其中N₁中第10组淋巴结阳性的有10例，占62.5%(10/16)，N₁+N₂中第10组淋巴结阳性的有18例，占72.0%(18/25)。第10组淋巴结转移率在T_1b期和T_1a期差异具有统计学意义(P < 0.05)，第10组淋巴结在低分化及中分化肺癌中的转移率分别为25.9%(21/81)和8.3%(7/84)，差异有统计学意义(χ2=9.060，P < 0.05)。  结论  NSCLC中第10组淋巴结转移与原发肿瘤大小、临床病理类型、分化程度密切相关，在N₁、N₁+N₂、N₂存在淋巴结转移的情况下，第10组淋巴结阳性的概率较大；因此，早期非小细胞肺癌患者接受手术时优先对第10组淋巴结进行病理检测，根据第10组淋巴结病理情况，决定下一步手术方案更具有科学性。 

Exploration of the pattern of lung hilar lymph node metastasis in cTNM-stage IA non-small cell lung cancer and its clinical significance

  Objective  To investigate the metastasis pattern of hilar lymph nodes (group 10 lymph nodes) in cTNM-ⅠA stage non-small cell lung cancer (NSCLC) and the clinical significance.  Methods  A retrospective analysis of tumor and lymph node pathology was performed in 233 patients with primary cTNM-stage Ⅰ NSCLC, who underwent lobectomy and systemic lymph node dissection from January 1, 2020 to January 1, 2021 in the thoracic surgery ward of the First Affiliated Hospital of Bengbu Medical College.  Results  A total of 3 145 lymph nodes were obtained from 233 patients, with an average of 13.5 lymph nodes per case, and 440 lymph nodes had cancer metastasis, with a metastasis rate of 14.0%. Among the 233 patients, 49 cases had intrathoracic lymph node metastasis, including 16 cases of N₁, 25 cases of N₁+N₂ [Note: N₁: metastasis of intrapulmonary lymph nodes alone; N₁+N₂: metastasis of N₂ (mediastinal group 2-9 lymph nodes) and N₁ (intrapulmonary group 10-14 lymph nodes) at the same time] and 8 cases of skipping status N₂, with a total metastasis rate of 21.0% (49/233). Among them, 10 cases were positive for group 10 lymph nodes in N₁, accounting for 62.5% (10/16), and 18 cases were positive for group 10 lymph nodes in N₁+N₂, accounting for 72.0% (18/25). The difference in metastasis rate of lymph nodes in group 10 was statistically significant between stage T_1b and stage T_1a (P < 0.05), and the metastasis rates of lymph nodes in group 10 in poorly and moderately differentiated lung cancer were 25.9% (21/81) and 8.3% (7/84), respectively, the difference was statistically significant (χ2=9.060, P < 0.05).  Conclusion  In NSCLC, group 10 lymph node metastasis is closely related to the primary tumor size, clinicopathological type and differentiation degree. In the case of lymph node metastasis in N₁, N₁+N₂ and N₂, the possibility of positive lymph node in group 10 is higher. Therefore, pathological detection of group 10 lymph nodes is a priority when NSCLC patients need a surgical operation, and it is more scientific to decide the subsequent surgical plan, depending on the pathological results.