肺纵隔淋巴结转移的临床预测

目的：探讨肺癌临床病理生理特征与纵隔淋巴结转移的相关性。方法：对378例行肺切除加纵隔淋巴结廓清术后的肺癌患者进行回顾性研究,应用Logistic回归分析判定预测有意义的相关性因素,应用X^2检测判定不同危险因素组间纵隔淋巴结转移发生率的判别。结果全部378例患者中,纵隔淋巴结转移105列,转移率为27．8％,多因素分析显示,腺癌、CT扫描阳性（纵隔淋巴结增大）和病理分别为T3是纵隔淋巴结转移有意义的预测指标（P＜0．001）。316例胸部CT扫描阴性患者中,纵隔淋巴结转移为23．4％（74／316）。多因素分析显示,腺癌、病理分期为T2和3腺癌患者的纵隔淋巴结转移发生率为33％,显著高于鳞癌的15．3％（P＜0．01）。结论对CT扫描阳性、腺癌及病理分期为T3的患者应该考虑有纵隔淋巴结转移可能性。对CT扫描阴性的临床分期T2和T3腺癌患者亦应高度怀疑纵隔淋巴结转移存在的可能性。

Prediction of ipsilateral mediastinal lymph node metastasis (N2 disease) in patients with lung cancer

Objective To determine the relation between the clinical pathophysiological characteristics and mediastinal lymph node metastasis (N2 disease) in patients with non small cell lung cancer(NSCLC). Methods A retrospective study was carried out. Between January, 1996, and October, 1999, 378 patients with NSCLC underwent mediastinal lymph nodes dissection, and 105 of them were proved to be N2 disease through pathological examination. A clinical lymph node staging (c N) was determined on the basis of findings of preoperative CT scan in each patient: mediastinal or hilar lymph nodes 1.0?cm or larger in the shortest axis were diagnosed as metastasis (c N1 2). Univariate and multivariate analysis were performed to determine the relationship between clinical predictors and pathologically proven N2 disease. Results Among all of the 378 cases, N2 disease accounted for 27.8%(105/378). c N2 disease, adenocarcinoma and c T3 tumor were the significant clinical predictors of pathological N2 disease on the basis of multivariate analysis (P<0.001). Among 316 patients with c N0 1 disease, N2 disease accounted for 23.4%(74/316). Adenocarcinoma and c T2 3 tumor were significant clinical predictors of pathologic N2 disease according to multivariate analysis procedure (P<0.05). When these predictors were combined, more than 50% of adenocarcinoma with c T3 tumor and about 40% of adenocarcinoma with c T2 tumor had N2 disease (P<0.01). Conclusion In the patients with adenocarcinoma and c T2 or c T3 tumor, probability of pathological N2 disease should be considered.