T1、T2肺鳞癌及腺癌淋巴结转移特点及其临床意义

目的研究T1、T2肺鳞及腺癌淋巴结转移频度、分布范围及特点,为广泛清扫提供依据。方法按Naruke肺癌淋巴结分布图对254例T1、T2肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵隔淋巴结清扫术并对其进行统计分析。结果清除淋巴结1685组。N1淋巴结转移率20．0％,N2淋巴结转移率为10．2％。T1、T2间淋巴结转移率差异有非常显著性意义(P<0．01)。T1鳞癌无N2转移,N2转移在鳞癌、腺癌分别为22．0％和40．9％,差异有非常显著性意义(P<0．01)。64．3％的鳞癌为某1组N2转移,腺癌≥3组转移占46．2％,跳跃式转移占N2转移的57．5％。N2阳性上叶肺癌下纵隔转移占13．6％,N2阳性的下叶肺癌上纵隔转移占51．6％。结论随着瘤体增大,淋巴结转移频度增加,腺癌比鳞癌淋巴结转移更加活跃,任何部位的肺癌都可跨区域纵隔转移。除T1鳞癌外,只有广泛清扫同侧肺内及纵隔淋巴结才能达到根治。     

肺鳞癌、腺癌纵隔淋巴结转移的特点

目的 研究原发肺鳞癌及腺癌纵隔淋巴结转移特点,探讨临床意义.方法 对353例原发肺癌施行同侧纵隔淋巴结廓清术,病理检测淋巴结转移频度.结果 清除淋巴结2380组,平均每例6.74组.N2 淋巴结转移率16.2%.T1、T2、T3间淋巴结转移率差异有统计学意义(P<0.01).N2转移率在鳞癌、腺癌分别为30.1%、44.1%.64.2% 鳞癌N2转移为某一组淋巴结,腺癌3组以上转移者46.2%.上叶肺癌跨区域N2转移占15.1%,下叶(包括中叶)肺癌跨区域转移占53.1%.跳跃式转移占N2转移的53.7%.结论 肺鳞癌及腺癌纵隔淋巴结转移具有多发性、跳跃性及跨区域性特点.     

T_1、T_2肺鳞癌及腺癌淋巴结转移特点及其临床意义

目的　研究T1、T2 肺鳞及腺癌淋巴结转移频度、分布范围及特点 ,为广泛清扫提供依据。　方法　按Naruke肺癌淋巴结分布图对 2 5 4例T1、T2 肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵隔淋巴结清扫术并对其进行统计分析。　结果　清除淋巴结 16 85组。N1淋巴结转移率 2 0 0 % ,N2 淋巴结转移率为 10 2 %。T1、T2 间淋巴结转移率差异有非常显著性意义 (P <0 0 1)。T1鳞癌无N2 转移 ,N2 转移在鳞癌、腺癌分别为 2 2 0 %和 40 9% ,差异有非常显著性意义 (P <0 0 1)。6 4 3%的鳞癌为某 1组N2 转移 ,腺癌≥ 3组转移占 46 2 % ,跳跃式转移占N2 转移的 5 7 5 %。N2 阳性上叶肺癌下纵隔转移占 13 6 % ,N2 阳性的下叶肺癌上纵隔转移占 5 1 6 %。　结论　随着瘤体增大 ,淋巴结转移频度增加 ,腺癌比鳞癌淋巴结转移更加活跃 ,任何部位的肺癌都可跨区域纵隔转移。除T1鳞癌外 ,只有广泛清扫同侧肺内及纵隔淋巴结才能达到根治。     

直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究

目的探讨直径≤3cm的周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的情况,分析早期周围型NSCLC纵隔淋巴结转移的规律。方法 2000年1月1日～2008年12月31日治疗直径≤3cm的周围型NSCLC161例,男89例,女72例,年龄(63.4±10.7)岁,行肺叶切除或肺局限性切除加系统性纵隔淋巴结清扫术,分析其临床特征、病理特点及纵隔淋巴结转移规律。结果全组手术顺利,无死亡及严重并发症发生。肺叶切除153例,肺楔形切除7例,肺段切除1例。全组共清扫淋巴结2456枚,平均每例4.5±1.6组、13.1±7.3枚。术后病理:腺癌99例,鳞癌30例,肺泡细胞癌19例,其他类型肺癌13例。术后TNM分期:ⅠA期50例,ⅠB期62例,ⅡA期6例,ⅡB期10例,ⅢA期33例。N1组淋巴结转移率为23.6%(38/161),N2组转移率为20.5%(33/161),其中隆突下淋巴结转移率为8.1%(13/161),跳跃式纵隔转移率为6.8%(11/161),全组未发现下纵隔淋巴结转移。肺泡细胞癌及直径≤2cm的鳞癌、直径≤1cm的腺癌均无pN2转移。上肺癌发生pN2转移时上纵隔100%(19/19)受累,其中21.1%(4/19)同时伴有隆突下淋巴结转移;下肺癌则除主要转移至隆突下外(64.3%,9/14),还常直接单独转移至上纵隔(35.7%,5/14)。转移的纵隔淋巴结左肺癌主要分布在第5、6、7组,右肺癌主要分布在第3、4、7组。结论对于直径≤3cm的周围型NSCLC,肿瘤直径越大,其纵隔淋巴结转移率越高,肺泡细胞癌、直径≤2cm的鳞癌和≤1cm的腺癌其纵隔淋巴结转移率相对较低;上肺癌主要转移在上纵隔,下肺癌则隆突下及上纵隔均可转移;第5、6、7组淋巴结是左肺癌主要转移的位置,第3、4、7组是右肺癌主要转移的位置,术中应重点清扫。     

肺癌跳跃式纵隔淋巴结转移的临床病理探讨

目的　探索肺癌跳跃式纵隔淋巴结转移的病理特点 ,为合理施行淋巴结清除术提供可靠的理论依据。方法　 1992年 10月至 1998年 6月 ,为 398例肺癌病人施行了根治性肺切除、规范淋巴结清除术 ,对其中 4 7例 ( 2 9 4 % )跳跃式纵隔转移淋巴结病例进行病理学研究。结果　各型或各叶肺癌中 ,跳跃式转移淋巴结分布最密集的部位依次是第 7、4、3、5组淋巴结 ,分别占 2 9 8%、2 4 5 %、14 9%与10 6 % ;就鳞癌与腺癌而言 ,肿瘤长径在 1cm以内者均无跳跃式淋巴结转移 ,跳跃式淋巴结转移率随长径增加而增加 ;低分化腺癌淋巴结转移率明显高于高分化者 (P <0 0 1) ;发生跳跃式淋巴结转移的肿瘤平均长径鳞癌与腺癌分别为 15 3mm与 9 1mm。结论　对肺癌淋巴结的廓清 ,切勿仅凭手触摸或靠肉眼观察淋巴结大小而盲目判定其是否转移或清除。除T1 中肿瘤长径 <1cm的鳞癌外 ,淋巴结的规范清除应重视其跳跃性 ,原则上必须包括同侧胸腔的肺门及上、下纵隔各组淋巴结 ,尤其要重视跳跃式淋巴结转移分布较密集区域 ,即右侧的第 3、4、7组与左侧的第 4、5、7组淋巴结     

非小细胞肺癌跳跃性纵隔淋巴结转移及其廓清的临床探讨

目的：探讨非小细胞肺癌（NSCLC）跳跃性纵隔淋巴结转移（跳跃性N2）的特点及转移方式，为制定合理的纵隔淋巴结廓清范围提供依据。方法：回顾性总结121例（广州军区总医院1996－1999年101例和北京大学深圳医院1999－2000年20例）经系统性淋巴结廓清后病理证实为N2的NSCLC患者的临床资料，将跳跃性N2与非跳跃性N2的数据进行比较。结果：发现跳跃性N2 23例（19．0％，其中腺癌18例（78．3％）。跳跃性N2患者中平均每例纵隔淋巴结转移组为1．1组，明显低于非跳跃性N2的3．1组。肺上叶肿瘤跳跃性N2多位于第4或第5组淋巴结，肺下叶肿瘤跳跃性N2多位于第7和第8组淋巴结。结论：跳跃性N2是NSCLC纵隔淋巴结转移的一个独特亚群。在行肺上叶癌根治术时，应常规清扫第4和第5组淋巴结；在行肺下叶癌根治术时，应常规清扫第7和第8组淋巴结。     

99例周围型小肺癌的TNM分期分析及临床意义探讨

目的 通过对周围型小肺癌的TNM分期进行分析,以提高临床医师对恶性肺小结节的重视,并探讨小肺癌系统性淋巴结清扫的必要性.方法 回顾性分析2005年1月至2013年6月99例行肺叶切除术＋系统性淋巴结清扫术的周围型小肺癌患者的临床资料,肿瘤及所有淋巴结均获得病理证实,然后进行TNM分期,分析各组淋巴结的转移情况,肿瘤T分期、淋巴结大小与淋巴结转移的关系.结果 病理T分期：T1a期71例（71.72%）,T2a期28例（28.28%）.22例患者有淋巴结转移（22.22%）,其中N1 12例（12.12%）、N2 10例（10.10%）.TNM分期：Ia期58例（58.59%）,Ib期18例（18.18%）,≥Ⅱa期者23例（23.23%）.共清扫胸内淋巴结1226枚,平均每例12.38枚,126枚淋巴结存在癌转移（10.28%）.T2a期淋巴结转移率明显高于T1a期（P＜0.05）.淋巴结直径0.5～1.0cm的转移率高于直径＜0.5cm者,但差异无统计学意义（P＞0.05）.结论 周围型小肺癌并不完全是早期肺癌,约1/4患者为≥Ⅱ期的中、晚期肺癌.对小肺癌患者进行系统性淋巴结清除术非常必要,不能以术中未触及肿大淋巴结而排除淋巴结的清扫.     

T1、T2肺鳞癌及腺癌淋巴结转移特点及其临床意义

目的 研究Ｔ１、Ｔ２肺鳞及腺癌淋巴结转移频度、分布范围及特点,为广泛清扫提供依据。方法 按Ｎａｒｕｋｅ肺癌淋巴结分布图对２５４例Ｔ１、Ｔ２肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵阴淋巴结清扫术并对其进行统计分析。结果 清除淋巴结１６８５组。Ｎ１淋巴结转移率２０．０％,Ｎ２淋巴结转移率为１０．２％。Ｔ１、Ｔ２间淋巴结转移率差异有非常显著性意义（Ｐ〈０．０１）。Ｔ１鳞癌无Ｎ２转移,Ｎ２转移在鳞癌     

非小细胞肺癌隆突下淋巴结转移与临床病理特征的关系

目的分析非小细胞肺癌隆突下淋巴结转移的方式和规律,以探讨其隆突下淋巴结合理的手术清扫方式。方法回顾性分析2002年9月至2011年10月河南省肿瘤医院608例非小细胞肺癌患者行肺切除加系统淋巴结清扫术的临床资料,其中男388例,女220例;平均年龄62.3(45～78)岁。肿瘤位于左肺上叶122例、左肺下叶119例、右肺上叶158例、右肺中叶40例和右肺下叶169例;隆突下淋巴结转移118例(19.4%)。病理类型:鳞癌244例,腺癌285例,其它癌79例。分析隆突下淋巴结转移与肺部肿瘤的部位、病理类型和临床病理特征的关系。结果不同肿瘤部位间发生隆突下淋巴结转移差异有统计学意义(P=0.000),右肺下叶肺癌发生隆突下淋巴结转移比率[45.8%(54/118)]最高;腺癌发生隆突下淋巴结转移比率[55.9%(66/118)]最高,其次为鳞癌(P=0.034)。随着肿瘤T分期的发展,隆突下淋巴结转移的可能性加大,并且左右肺中下叶癌患者隆突下淋巴结转移率大于肺上叶癌患者。结论肿瘤位于左肺或右肺上叶、临床T分期为cT1以内的鳞癌患者,隆突下淋巴结转移的可能性小。     

直径≤3cm的周围型肺腺癌淋巴结转移分析

目的探讨原发性周围型小肺腺癌(直径≤3cm)淋巴结转移的规律,为治疗方案的制定提供参考。方法自1990年1月至2009年1月期间,首都医科大学附属北京友谊医院胸外科手术治疗肿瘤最大直径(CT测量)≤3 cm的周围型原发性肺腺癌288例,其中男223例,女65例;年龄30~73岁。288例患者诊断均经病理检查证实,临床诊断淋巴结转移的标准为最小直径大于1.0 cm(CT)。手术方式:肺叶切除术264例,肺袖式切除术22例,肺楔形切除术2例;纵隔淋巴结清扫方式为系统纵隔淋巴结清扫或采样。结果 288例中发生淋巴结转移142例(49.30%),其中术后分期为N190例(31.25%),N252例(18.06%)。不同原发部位的淋巴结转移率:右肺46.67%(77/165),左肺56.10%(69/123);肿瘤直径小于1 cm者淋巴结转移率为22.22%(2/9),1~2 cm之间者为39.44%(28/71),2~3 cm之间者为53.84%(112/208),三者间比较差异有统计学意义(P0.01)。直径小于1 cm者未发现N2转移,1~2 cm之间者N2阳性率为14.08%(10/71),2~3 cm之间者N2阳性率为20.19%(42/208),三者间比较差异有统计学意义(χ2=20.01,P0.01)。结论周围型小肺腺癌肺门及纵隔淋巴结转移常见,尤其是右肺上叶肺癌。直径大小对腺癌淋巴结转移发生率有明显的影响,但即便直径小于2 cm,淋巴结转移仍有很大的风险。术前应尽可能获得准确的N分期,如不能在术前确定N分期,对直径1 cm以上的肺腺癌术中应常规进行纵隔淋巴结清扫,否则难以获得准确的分期,亦难以达到根治性切除。     

肺癌淋巴结转移规律的临床研究

目的 探讨原发性肺癌淋巴结转移频率,分布范围及特点,为广泛廓清提供依据。方法 按Ｎａｒｕｋｅ肺癌淋巴结分布图对３８６例肺癌病人施行了手术切除及广泛肺门、叶间及纵隔淋巴结廓清术。结果 清除淋巴结２６０３组,Ｎ１淋巴结转移率２０．１％,Ｎ２淋巴结转移率１６．２％。Ｔ１,Ｔ２,Ｔ３间淋巴结经差异非常显著。     

21-year-old man with squamous cell carcinoma of the lung

Lung cancer among people in their twenties is rare and accounts for only 0.1-0.4% of all cases. We describe a case of squamous cell carcinoma of the lung in a 21-year-old man. The otherwise healthy patient presented with a 1 month history of cough. Chest radiography showed a well-defined round mass 5 cm in size in the right lower lobe. Computed tomography also showed a 3 cm hilar lymph node. Bronchoscopy revealed a white polypoid mass obstructing the right basal bronchus. Transbronchial biopsy revealed poorly differentiated squamous cell carcinoma of the lung. Clinical diagnosis was T2N1M0, stage IIB lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed. Lymph node metastases were proven histologically in the pretracheal, subcarinal, hilar, and intrapulmonary regions. Pathological diagnosis was T2N2M0, stage IIIA lung cancer. Endobronchial and mediastinal lymph node metastases were found 2 months after surgery. He received 3 rounds of chemotherapy with cisplatin and docetaxel and irradiation to the right hilum and mediastinum at a total dose of 60 Gy in 30 fractions. He is alive 6 months after surgery.     

Surgical treatment of non-small cell lung cancer 1 cm or less in diameter

BACKGROUND: Routine lung cancer screening does not currently exist in the United States. Computed tomography can detect small cancers and may well be the screening choice in the future. Controversy exists, however, regarding the surgical management of these small lung cancers. METHODS: The records of all patients were reviewed who underwent resection of solitary non-small cell lung cancers 1 cm or less in diameter from 1980 through 1999. RESULTS: The study included 100 patients (56 men and 44 women) with a median age of 67 years (range 43 to 84 years). Lobectomy was performed in 71 patients, bilobectomy in 4, segmentectomy in 12, and wedge excision in 13. Ninety-four patients had complete mediastinal lymph node dissection. The cancer was an adenocarcinoma in 48 patients, squamous cell carcinoma in 26, bronchioloalveolar carcinoma in 19, large cell carcinoma in 4, adenosquamous cell carcinoma in 2, and undifferentiated in 1. Tumor diameter ranged from 3 to 10 mm. Seven patients had lymph node metastases (N1, 5 patients; N2, 2 patients). Postsurgical stage was IA in 92 patients, IB in 1, IIA in 5, and IIIA in 2. There were four operative deaths. Follow-up was complete in all patients and ranged from 4 to 214 months (median 43 months). Eighteen patients (18.0%) developed recurrent lung cancer. Overall and lung cancer-specific 5-year survivals were 64.1% and 85.4%, respectively. Patients who underwent lobectomy had significantly better survival and fewer recurrences than patients who had wedge excision or segmentectomy (p = 0.04). CONCLUSIONS: Because recurrent cancer and lymph node metastasis can occur in patients with non-small cell lung cancers 1 cm or less in size, lobectomy with lymph node dissection is warranted when medically possible.     

A clinical study of small advanced lung cancer with metastasis to mediastinal lymph node

From January 1981 through December 1989, 15 patients with small advanced lung cancer were treated surgically at the Tenri Hospital. In these cases, the diameter of peripheral lung cancer did not exceed 3.0 cm (T1) and mediastinal lymph nodes were proved to be N2 postoperatively by lymph node dissection or sampling. The histological types were as follows: 8 adenocarcinoma, 4 large cell carcinoma, 1 squamous cell carcinoma, 1 small cell carcinoma, and 1 adenosquamous carcinoma. All but one patient were received postoperative chemotherapy and/or radiotherapy. The survival rate was 44.5% at 3 years, and median survival time was 36 months. The mediastinal lymph node metastasis with small peripheral lung cancer (T1N2) was ominous, and it should be said that complete mediastinal lymph node dissection and adjuvant therapy were indispensable to small advanced adenocarcinoma of lung.     

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.     

Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients.

OBJECTIVE: We retrospectively reviewed nodal status of the patients with peripheral small-sized lung cancer grouped by cell type and tumor size to evaluate the necessity of systematic nodal dissection in this group of patients. METHODS: From 1973 to 1998, 1713 patients underwent pulmonary resection for primary lung cancer in Kanazawa University. Among them, 225 patients (13.1%) with peripheral small-sized (2 cm or less) lung cancer underwent lobectomy and systematic nodal dissection were retrospectively reviewed. The maximum diameter of the tumor was measured on formalin-fixed surgical specimens. RESULTS: The histological types were adenocarcinoma in 170 (75.6%), squamous cell carcinoma in 20 (8.9%), small cell carcinoma in 19 (8.4%) and others in 16 (7.1%). Among 170 adenocarcinoma patients, 38 (22.4%) showed hilar or mediastinal lymph node metastases. No mediastinal lymph node metastasis was encountered in all squamous cell carcinoma (n = 20), adenocarcinoma < or = 1 cm (n = 16), small cell carcinoma < or = 1 cm (n = 4), and adenocarcinoma of Noguchi's classification type A or B (n = 24). CONCLUSIONS: Mediastinal nodal dissection would be unnecessary in the patients with peripheral small-sized lung cancer fulfilling these criteria: (1) squamous cell carcinoma < or = 2 cm; (2) adenocarcinoma < or = 1 cm; (3) localized bronchioloalveolar carcinoma < or = 2 cm without foci of active fibroblastic proliferation in histology (Noguchi's classification type A or B adenocarcinoma); (4) small cell carcinoma < or = 1 cm. Candidates fulfilling above criteria were 28.4% (64/225) of small-sized lung cancer and 10.9% of stage IA patients. The establishment of a universally accepted therapeutic strategy for small-sized lung cancer is indispensable in the clinical spread of various sort of limited resections.     

The adequate diagnostic criterion of mediastinal lymph node size for detection of metastasis in primary lung cancer

The size of lymph node is one of the most important factor in evaluation of lymph node metastasis in lung cancer. The most appropriate size for detecting lung cancer lymph node metastasis was studied by 2403 dissected lymph nodes in 75 operated cases of lung cancer. From the result of Receiver Operating Characteristic (ROC) curve analysis, long-axis diameter of the lymph node showed higher accuracy of diagnosis of metastasis than short-axis diameter. Metastasis of squamous cell carcinoma was diagnosed more accurately than that of adenocarcinoma. The most adequate threshold for detection of metastasis in squamous cell carcinoma was 10 mm in long-axis diameter with sensitivity of 73.8% and specificity of 78%. On the other hand, that of adenocarcinoma was 7 mm in long-axis diameter with sensitivity of 65.7% and specificity of 55.9%. That threshold value of adenocarcinoma was approximate to the value of normal lymph node size in the mediastinum. It was suggested that the size for detection of lymph node metastasis was depended upon histological type, and detection of lymph node metastasis in adenocarcinoma was extremely difficult.