Analysis of risk factors for skip lymphatic metastasis and their prognostic value in operated N2 non-small-cell lung carcinoma.

BACKGROUND: The aim of this study is to report a series and to analyze risk factors for skip lymphatic metastasis an their prognostic value in operated N2 non-small-cell lung carcinoma. METHODS: From 1997 to 2002, 142 patients classified pN2 were included in the study. Tumours were classified according to the TNM classification. Skips metastases were defined by the cases of N2 disease without lobar and interlobar and hilar lymph node involvement. A skip (+) and a skip (-) group were defined. Characteristics of tumours, ganglionar involvement and survival were analysed in both groups. RESULTS: Forty-two patients fulfilled the criteria for skip metastasis. The average number of mediastinal lymph nodes resected by patient was similar in both groups, whereas more intrapulmonary nodes were dissected in the skip (-) group (4.7 +/- 3 vs 3 +/- 3; p < 0.002). The ratio of involved to resected lymph nodes was 0.47 +/- 0.27 in the skip (-) group vs 0.23 +/- 0.20 in the skip (+) group (p < 0.0001). In the skip (+) group, 85% of the patients presenting with a right upper lobe tumour had involvement of the superior mediastinal lymph nodes against 40% in the skip (-) group. The 5-year survival rate was 48% in the skip (-) group vs 37% in the skip (+) group (p = 0.49). In multivariate analysis, incomplete resection, tumour size, extended resection and pT were significant prognostic factors. CONCLUSIONS: Skip metastasis are frequent in non-small-cell lung cancer and complete dissection of hilar and mediastinal lymph nodes should remain the surgical standard procedure for this disease. However, skip metastasis are not an independent prognostic factor in survival.     

Skip metastasis in nonsmall cell lung carcinoma: predictive markers and isolated tumor cells in N1 lymph nodes

BACKGROUND: Skip metastasis to mediastinal lymph nodes is a prognostic factor for patients with nonsmall cell lung carcinoma (NSCLC). Little is known about the biologic behavior of tumors with noncontinuous spread to the mediastinal lymph nodes. In patients with pN2 skip metastases, micrometastases to N1 lymph nodes, which only mimic skip metastases, have not been investigated. METHODS: In a retrospective study, the authors analyzed the primary tumor specimens from 45 patients with pN2 NSCLC (18 patients had squamous cell carcinomas, 23 had adenocarcinomas, and 4 had large cell carcinomas). They immunohistochemically evaluated the expression of p21, p53, MUC-1, Bcl-2, c-ErbB-2, and E-cadherin. Survival rates and biomarker expression levels were compared between patients with pN2 disease and infiltration of N1 lymph nodes (without skip metastasis [n = 28]) and patients with pN2 disease without N1 infiltration (with skip metastasis [n = 17]). To evaluate micrometastasis in the pN1 lymph nodes of 17 patients with skip metastases, lymph nodes were stained using the anticytokeratin antibody, AE1/AE3. RESULTS: The 5-year survival rate of patients with skip metastases was 41%, compared with 14% for patients without skip metastases (P = 0.019). In a multivariate analysis, the incidence of skip metastases did not vary significantly according to gender, age, histology, pT status, or cM status. Three skip-positive patients (17.6%) had micrometastatic tumor involvement of pN1 lymph nodes. After adding these patients to the group of patients without skip metastases, there was still a significant difference in survival between the two groups. p53, MUC-1, c-ErbB-2, and E-cadherin expression levels in primary tumor specimens were not significantly different in patients with continuous metastasis and patients with skip metastases. Patients with skip metastases expressed lower levels of p21 (P = 0.026), whereas Bcl-2 expression levels were considerably higher (P = 0.019) compared with the corresponding levels in patients without skip metastases. CONCLUSIONS: Patients with NSCLC and pN2 skip metastases have a more favorable prognosis than do patients with pN2 disease without skip metastases. Tumor specimens from these patients exhibit elevated expression of the antiapoptosis gene BCL2 and lower expression levels of p21 relative to patients with pN2 disease without skip metastases. Micrometastases occurred in 3 of 17 (17.6%) patients with pN2 disease and skip metastases diagnosed by routine histopathology.     

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。     

非小细胞肺癌淋巴结转移规律分析

背景与目的:淋巴结转移是肺癌最常见的转移途径,影响分期和预后,胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在对非小细胞肺癌(non-small cell lung cancer,NSCLC)术后淋巴结转移特点进行分析,为手术选择淋巴结清扫范围提供参考依据。方法:205例NSCLC手术病例,比较胸内各组淋巴结转移情况,从肿瘤原发部位和肿瘤组织类型两方面比较各分组之间淋巴结转移率及跳跃性转移率的差异。结果:205例NSCLC术中共清扫胸内淋巴结977组共3 577枚,平均每例17.4枚。其中220组共508个淋巴结存在转移,有胸内淋巴结转移病例98例,转移率为47.8%。发生跳跃性转移35例,转移率为17.1%。第4、5、7、10、11组淋巴结转移频度较高。肺上叶癌比肺下(中)叶癌更容易发生跳跃性转移。腺癌的淋巴结转移率明显高于鳞癌。结论:NSCLC的淋巴结转移多数是按肺内淋巴结到肺门淋巴结再到纵隔淋巴结的顺序进行逐级转移,纵隔淋巴结的跳跃性转移比较常见。NSCLC的淋巴结转移特点与肿瘤的原发部位、肿瘤组织类型有密切关系。手术应根据淋巴结转移规律对胸内淋巴结进行系统性清扫,特别注意转移频率较高的第4、5、7、10、11组淋巴结。     

Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status

BACKGROUND:

In patients with nonsmall cell lung carcinoma (NSCLC) who have with pathologic N1 (pN1) lymph node status, the prognostic significance of segmental lymph node (level 13) metastasis and/or subsegmental lymph node (level 14) metastasis is unknown.

METHODS:

Lymph node metastasis patterns were analyzed in 230 patients with NSCLC who had pN1 status. Clinical outcomes were examined for 230 patients with pN1 status and 700 patients with pN0 status. The pN1 group was stratified into 4 subgroups according to the highest level of lymph node involvement.

RESULTS:

The 5‐year disease‐free survival (5DFS) rates for pN1 and pN0 patients were 50.1% and 90.5%, respectively. The highest level of lymph node involvement was a significant prognostic indicator; the 5DFS rates for patients with pN1 status who had level 13/14, lobar (level 12), interlobar (level 11), and hilar (level 10) lymph node metastasis were 69.4%, 46.4%, 46.7%, and 37%, respectively. Patient outcomes were significantly worse for those with pN1 status who had only level 13/14 lymph node metastasis than for patients with pN0 status (P = .0034), and outcomes were significantly worse for patients with pN1 status who had level 11/12 lymph node metastasis than for patients who had only level 13/14 lymph node metastasis (P = .021). The median number of level 13/14 lymph nodes examined was 3 (range, 0‐22 level 13/14 lymph nodes), and metastases to these lymph nodes were detected in 61% of patients who had pN1 status. A single lymph node pN1 disease, single‐level pN1 status, and squamous cell carcinoma histopathology also were indicators of a better patient outcome.

CONCLUSIONS:

The current results indicated that the highest level of lymph node involvement may be used to stratify the outcome of patients who have NSCLC with pN1 status. Patients with pN1 status who had only level 13/14 lymph node metastasis had an intermediate 5DFS rate between that of patients with pN0 status and other patients with pN1 status. Routine examination of level 13/14 lymph nodes is important for accurate pathologic staging and for the predicting clinical outcome of patients with NSCLC. Cancer 2012. © 2012 American Cancer Society.     

非小细胞肺癌纵隔淋巴结转移危险因素分析及术前纵隔镜检查的应用策略

目的 探讨纵隔镜技术评估非小细胞肺癌(NSCLC)术前纵隔淋巴结状态(是否存在转移)的临床应用策略.方法 2000年10月至2007年6月,对临床连续收治的经病理确诊的临床分期为Ⅰ～Ⅲ期的NSCLC患者152例,分别采用CT和纵隔镜技术评估纵隔淋巴结状态.根据纵隔淋巴结最终病理结果,计算CT下纵隔肺门淋巴结阴性NSCLC的纵隔镜检查阳性率和实际纵隔淋巴结转移发生率.以患者性别、年龄、肿瘤部位、病理类型、肿瘤T分期、肿瘤类型(中央型或外周型)、CT下纵隔淋巴结大小和血清癌胚抗原(CEA)水平等作为预测因子,进行纵隔淋巴结转移危险因素的单因素和多因素分析.结果 69例CT下纵隔肺门淋巴结阴性NSCLC,纵隔镜检查阳性8例,阳性率为11.6%;实际纵隔淋巴结转移14例,发生率为20.1%.62例临床Ⅰ期(cT1～2NOMO)NSCLC,纵隔镜检查阳性7例,阳性率为11.3%;实际纵隔淋巴结转移12例,发生率为19.4%.对全部152例NSCLC患者纵隔淋巴结转移危险因素的分析结果显示,病理类型和CT下纵隔淋巴结大小是纵隔淋巴结转移的独立危险因素.对69例CT下纵隔肺门淋巴结阴性NSCLC患者纵隔淋巴结转移危险因素的分析结果显示,病理类型是纵隔淋巴结转移的独立危险因素.结论 对于CT下纵隔淋巴结短径≥1 cm的NSCLC患者,术前必须进行纵隔镜检查;对于腺癌患者,即使是CT下纵隔肺门淋巴结短径<1 cm,术前也应该进行纵隔镜检查.     

Ⅲa-N2非小细胞肺癌纵隔淋巴结转移综合模式的预后价值

  目的  研究跳跃转移与肺叶特异性转移对Ⅲa-N2非小细胞肺癌（non small cell lung cancer,NSCLC）的预后意义。  方法  天津医科大学肿瘤医院2008年1月至2009年12月行完全切除和系统淋巴结清扫的218例pN2期NSCLC被纳入本研究。根据有无N1区淋巴结转移将分为连续转移与跳跃性转移;根据纵隔淋巴结转移范围是否超出肺叶特异性区域分为纵隔广泛转移与肺叶特异性转移。对各组的总生存（overall survival,OS）和无病生存（disease free survival,DFS）进行了比较。  结果  全组患者的5年OS为21.6%,5年DFS为16.8%。跳跃性转移及连续转移病例的5年OS分别为37.6%和22.0%（P =0.008）;DFS分别为29.1%和15.0%（P =0.022）。肺叶特异性转移和广泛转移的5年OS分别为38.3%和20.4%（P =0.005）;DFS分别为28.4%和15.1%（P =0.009）。根据两者的组合将所有患者进一步分为3组:仅有跳跃性转移和肺叶特异性转移（A组）,发生连续转移或者纵隔广泛转移中的一项（B组）;既有连续转移又有纵隔广泛转移（C组）。3组的5年OS分别为47.1%,28.1%和16.6%（P =0.001）;5年DFS分别为35.2%,20.8%和11.2%（P =0.002）。多因素分析表明,这种综合转移模式是OS和DFS的独立预后因素。  结论  淋巴结转移的综合模式是Ⅲa-N2的一种独立的预后因素,在评价患者预后及筛选术后治疗患者时应该将这种综合模式考虑在内。      

Prognostic impact of the primary tumor location based on the hilar structures in non-small cell lung cancer with mediastinal lymph node metastasis

The status of mediastinal lymph node metastasis is one of the main factors determining the treatment strategy for non-small cell lung cancer (NSCLC), but the primary tumor location is not considered crucial in the tumor-node-metastasis (TMN) classification at present. The aim of this study was to estimate the prognostic value of the primary tumor location on the basis of the hilar structures in NSCLC with mediastinal lymph node metastasis. We retrospectively reviewed the cases of 337 consecutive patients who underwent surgical resection for NSCLC between 1995 and 2004, divided the pN2 NSCLC cases (n=40) into central- and peripheral-type tumors according to the distance of the primary tumor from the first branch of the extrapulmonary bronchus, and compared the surgical outcomes between these tumor groups. Eighteen and twenty-two cases were classified as central- and peripheral-type tumors, respectively. The 5-year survival rate was significantly better for patients with central-type tumors than peripheral-type tumors (51.5% vs. 21.2%, P=0.034). The location-specific prognostic tendency was noted irrespective of the presence (n=13) or absence of skip metastasis. In a multivariate Cox analysis of the N2 NSCLC cases, the primary tumor location was a significant (P=0.026) prognostic factor for overall survival. In conclusion, evaluation of the primary tumor location based on the hilar structures is useful to predict the prognosis in N2 NSCLC.     

肺癌纵隔淋巴结合理廓清范围的临床探讨

目的：探讨非小细胞肺癌(NSCLC)纵隔淋巴结转移方式。方法：回顾性研究1989年1月—1999年1月，淋巴结廓清术后病理证实的纵隔淋巴结转移(pN2)137例。分析临床病理因素与pN2的关系．应用Logistic回归分析判定纵隔淋巴结CT扫描阴性时(cN0-1)pN2有意义的预测指标；总结不同位置肺癌纵隔淋巴结转移的方式。结果：NSCLC无论病理类型和临床状态如何，均有纵隔淋巴结转移发生。纵隔淋巴结增大(cN2)和cT2或cT3腺癌患者转移的发生率较高(65．0％，75．0％)。纵隔淋巴结转移多为区域性(80．9％)，跨区域纵隔淋巴结转移多数伴有隆凸下淋巴结受累。结论：对NSCLC应行纵隔淋巴结廓清，尤其对cN2和cT3、cT3腺癌。多数患者单独廓清区域纵隔淋巴结即可达到目的。建议手术中对肺门和隆凸下淋巴结冰冻病理检查，无转移时可不必廓清非区域纵隔淋巴结。     

Five-year survivors with resected pN2 nonsmall cell lung carcinoma

BACKGROUND: Some patients with resected pN2 lung carcinoma were long term survivors. To determine appropriate therapeutic modalities for the selected patients, the clinicopathologic characteristics of these patients were examined using the actual number of survivors rather than the cumulative survival rate because the cumulative survival rate occasionally is confounded due to patients with short follow-up periods. METHODS: Between 1981-1990, 178 patients with pN2 nonsmall cell lung carcinoma underwent complete resection with systemic lymph node dissection. The ratios of 5-year survivors to all patients in groups with several clinicopathologic factors were compared. RESULTS: Gender, the side that was operated on, location of the tumor, histologic type, or surgical procedure were not related to the ratio of 5-year survivors. However, T classification, skip metastasis, and the number of levels involved were associated with the ratio significantly. The authors also found that the location of the involved lymph node(s) affected the ratio. CONCLUSIONS: Even in the presence of pN2 disease, lung carcinoma patients with T1 tumors, skip metastasis, or single level mediastinal lymph node involvement, especially Level 4, Level 5, or Level 6 lymph nodes, had a relatively favorable prognosis and may be candidates for primary resection.     

Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer

N1 non-small cell lung cancer (NSCLC) encompasses a heterogeneous subgroup with differential lymph node involvement. Among 738 patients with NSCLC who underwent surgical resection, including 579 patients (78.5%) with systematic hilar and mediastinal lymph nodal dissection, from 1992 to 2001, 82 patients were pathologically defined as having N1 disease. We retrospectively analyzed the factors influencing survival, including the characteristics of lymph node involvement; the location of involved stations, the number of involved stations, the number of involved nodes, and the status of nodal involvement (microscopic N1, nodal involvement first defined by postoperative histological examination; or macroscopic N1, nodal involvement obviously recognized by preoperative examinations or surgical explorations). The overall 5-year survival rate of the 82 patients with N1 disease was 50.9%. No significant differences in the overall survival were found with regard to gender, age, histologic type, type of resection, or adjuvant therapies. Pathologic T status significantly influenced the overall survival (T1 versus T2 disease, P=0.008). According to the characteristics of lymph node involvement, the prognosis of patients with multiple-node N1 involvement was significantly poorer than that of those with single-node N1 involvement (5-year survival: 29.6% versus 61.5%, p=0.003). The prognosis of patients with macroscopic N1 disease was significantly poorer than that of those with microscopic N1 disease (5-year survival: 43.0% versus 65.0%, P=0.046). By comparison with the survival of patients who underwent surgical resection during the same period for pathologic N0 (pN0) and pathologic N2 (pN2) diseases, no survival differences were observed between microscopic N1/single-node N1 and pN0, or between multiple-node N1 and pN2 diseases. In patients with pathologic N1 disease, microscopic N1 and single-node N1 diseases may be an early stage, whereas multiple-node N1 disease behaves like an advanced stage.     

256排CT三期增强扫描对NSCLC纵膈淋巴结转移及分布规律的评估分析

目的经256排CT三期增强扫描评估非小细胞肺癌(NSCLC)纵膈淋巴结转移及分布规律。方法回顾性分析149例NSCLC患者临床资料,所有患者术前均经256排CT三期增强扫描检查。分析不同肿瘤大小、胸膜凹陷、累及粗大肺静脉、淋巴结短径、肿大淋巴结位置、肿瘤位置情况下纵膈淋巴结转移情况,分析不同直径淋巴结在各区域分布情况。结果 149例NSCLC患者共清扫淋巴结980组,共2903枚,病理证实91例患者142组588枚淋巴结存在转移,淋巴结转移率61.07%;不同肿瘤大小、胸膜凹陷情况、累及粗大肺静脉情况、肿大淋巴结位置NSCLC患者淋巴结转移率比较差异均有统计学意义(P<0.05);淋巴结短径≤1 cm NSCLC患者淋巴结转移率明显低于淋巴结短径>1 cm者(P<0.05);阳性转移淋巴结主要分布在纵膈淋巴结上区、N1淋巴结区,阴性转移淋巴结主要分布在纵膈淋巴结上区、主动脉淋巴结AP区,不同性质淋巴结转移在各区域分布存在显著差异(P<0.05)。结论 256排CT三期增强扫描能及时发现NSCLC纵膈淋巴转移,结合NSCLC临床特征及淋巴结分布特点能进一步评估NS...     

In vivo identification of sentinel lymph nodes for clinical stage I non-small cell lung cancer for abbreviation of mediastinal lymph node dissection

BACKGROUND: We previously reported that an identification of sentinel lymph node (SN) with a techenetium-99m (99mTc) tin colloid by ex vivo counting, i.e. the radio-activity of dissected lymph nodes, was a reliable method of establishing the first site of nodal metastasis in non-small cell lung cancer [J. Thorac. Cardiovasc. Surg. 124(2002)486]. However, for SN navigation surgery, SN should be identified before lymph node dissection (in vivo) but not after that (ex vivo). In order to reduce mediastinal lymph node dissection for clinical stage I non-small cell lung cancer (NSCLC) by SN navigation surgery, the SN identifications for hilar lymph nodes by ex vivo counting, and for mediastinal lymph nodes by in vivo, were evaluated. METHODS: Intra-operative SN identification using 99mTc tin colloid was conducted on 104 patients with clinical stage I NSCLC who had had major lung resections with mediastinal lymph node dissections. The hilar SNs were identified by ex vivo counting (after lung resection) and the mediastinal SNs were identified by in vivo counting (before lymph node dissection). To evaluate the accuracy of mediastinal SN identification by in vivo counting, it was compared with the data by ex vivo counting. RESULTS: SNs were identified in 84 patients (81%). SNs were identified at the hilum by ex vivo counting in 78 patients (93%) and at the mediastinum by in vivo counting in 40 patients (48%). While 15 patients had lymph node metastases, i.e. N1 in six and N2 in nine, the SNs could be found to have metastases during operation in 13 of the 15 patients (87%). The in vivo counting of the mediastinum missed out the mediastinal SNs identified by ex vivo counting in four of the 84 patients (5%). CONCLUSION: If the hilar SNs identified by ex vivo counting and the mediastinal SNs identified by in vivo counting had no metastases, then mediastinal lymph node dissection could be abbreviated for patients with clinical stage I NSCLC.     

Ⅲ期N2非小细胞肺癌的外科治疗

目的：探讨Ⅲ期N2非小细胞肺癌（NSCLC）患者外科治疗的疗效及影响预后的因素。方法：回顾性分析1982－1996年手术治疗的266例Ⅲ期N2 NSCLC患者的5年生存率,与同期手术的N0、N1患者做比较,用Cox模型分析病理分型、淋巴结转移数目、淋巴结转移区域、手术方式、T状态、手术性质等对N2的NSCLC患者预后的影响。结果：266例Ⅲ期N2的NSCLC患者的5年生存率为17．3％,明显低于同期N0、N1患者的5年生存率（51．4％和30．4％）,淋巴结转移数目、淋巴结转移区域、T状态、手术性质为影响预后的重要因素。结论：对单区域纵隔淋巴结转移且估计能完全切除的Ⅲ期N2（特别是T1）NSCLC应采取以手术为主的综合治疗。     

非小细胞肺癌的淋巴结转移相关因素及规律的探讨

  目的  探讨原发性非小细胞肺癌(NSCLC)年龄、性别、吸烟指数、肿瘤大小、病理类型、细胞分化程度与淋巴结转移的关系, 分析纵隔淋巴结转移的临床规律及分布特点。  方法  对96例非小细胞肺癌行肺切除术和淋巴结清扫术的患者进行临床病理分析。  结果  淋巴结转移与年龄、性别、吸烟指数无关, 肿瘤大小与淋巴结转移差异无统计学意义。高、中、低分化癌淋巴结转移率分别为15.8%、47.8%和59.0%, 肿瘤分化程度越低, 纵隔淋巴结转移率越高(P < 0.05)。病理类型与淋巴结转移无相关性, 鳞癌、腺癌的N₂转移率分别为13.6%、34.0%。肺腺癌较鳞癌易发生纵隔淋巴结转移(P < 0.05)。中心型肺癌与周围型肺癌纵隔淋巴结转移率差异无统计学意义(P > 0.05)。跳跃性N₂有12例, 跳跃式纵隔转移共9例。肺癌常跨区域纵隔转移, 肺下叶癌跨区域纵隔转移与肺上叶癌比较差异无统计学意义(P > 0.05)。  结论  非小细胞肺癌的淋巴结转移与细胞分化程度有密切关系, 与年龄、性别、吸烟指数、病理类型、原发肿瘤大小无关; 肺腺癌较鳞癌易发生纵隔淋巴结转移; 多数肺癌的淋巴结转移遵循由近及远、自上而下、由肺内经肺门再向纵隔的顺序转移规律; 部分纵隔淋巴结的转移呈"跳跃式"; 肺切除术时,施行系统性胸内淋巴结清扫是必要的。      

前哨淋巴结检测对预测非小细胞肺癌淋巴结转移的价值

背景与目的:区域淋巴结的转移状态是影响非小细胞肺癌(non-smallcelllungcancer,NSCLC)预后的重要因素之一。前哨淋巴结(sentinellymphnode,SLN)检测技术提供了一种术中快速高效检测淋巴结微转移的手段,但目前SLN技术应用于NSCLC尚不成熟。本实验旨在探索NSCLC根治术中SLN检测的可行性,评价SLN预测区域淋巴结转移状态的准确性。方法:应用染料法对50例NSCLC患者在根治术中于肺肿瘤边缘分4点(3、6、9、12点处)注入异硫蓝溶液4ml,进行SLN活检识别。结果:50例NSCLC患者中共有33例找到蓝染前哨淋巴结,检出率为66.0%。SLN发生于N1淋巴结24例(72.7%)、N2淋巴结6例(18.2%)、同时发生于N1和N2淋巴结3例(9.1%)。SLN识别的灵敏度为73.3%、假阴性率为26.7%、准确率为87.9%。结论:SLN对非小细胞肺癌肺门纵隔淋巴结转移具有预测性。     

Regional chemotherapy for colorectal liver metastases: Thirty years without patient benefit

We retrospectively investigated 186 non-small cell lung cancer cases with N2 disease in order to clarify the significance of skip metastasis. Of the 186 patients with N2 disease, negative N1 nodes recognized to be skip metastasis were seen in 62 patients (33%). The incidence of skip metastasis was not statistically different regarding histology, T status, or M status. The incidence of the skip metastatic site consisted of 35 cases (56%) at sites 1, 2 and 3, while 8 cases (13%) were found at sites 8 and 9. Among the patients with right lung cancer, the skip metastatic incidence for site 7 (subcarinal) was higher in patients with either middle lobe or lower lobe cancer than in those with upper lobe cancer (P < 0.05). The 5-year survival rates of all N2 patients in comparison to those with skip metastasis were 22% and 24%, respectively. When the sites of mediastinal lymph nodes were classified as superior, aortic, and inferior, the 5-year survival rates of the patients with superior skip metastasis, aortic metastasis, and inferior metastasis were 23%, 36%, and 15%, respectively. No statistical difference was observed. The 5-year survival rate of the skip N2 patients with only aortic region involvement was 50% (n=7). However, no statistically significant difference was found between the two groups (P=0.08). Our results thus suggested that mediastinal involvement for the aortic region alone might have a better prognosis than the others. We thus conclude that a dissection of the complete hilar and mediastinal lymph nodes should be the procedure of choice in standard operations for non-small cell lung cancer because of the high frequency of skip metastasis. © 1994 Wiley-Liss, Inc.     

非小细胞肺癌术前肺门纵隔淋巴结CT检查和术后病理结果比较的研究

目的 :比较非小细胞肺癌 (NSCLC)患者术前肺门纵隔淋巴结CT检查结果和术中淋巴结情况以及术后病理检查淋巴结转移情况 ,分析探讨CT检查对于诊断肺癌患者肺门纵隔淋巴结转移的价值。方法 :2 0 0 1年 6月 - 2 0 0 3年 5月在我院行手术切除的 86例资料完整的NSCLC患者 ,全部患者均有术前胸部CT、术中肺门纵隔淋巴结描述以及术后病理检查淋巴结转移与否的结果。CT和手术诊断淋巴结异常的标准是 :淋巴结最小径≥ 10mm ,CT检查和术中检查淋巴结异常相一致者定义为敏感性 ,CT发现淋巴结异常而病理报道为淋巴结转移者定义为特异性。结果 :CT检查肺门纵隔淋巴结转移的敏感性和特异性与淋巴结的大小关系密切 ,当淋巴结短径 <10mm时淋巴结的转移率为 16 % (12 77) ;10～19mm时转移率为 4 0 % (5 4 136 ) ;2 0～ 2 9mm时转移率为 75 % (2 7 36 ) ;≥ 30mm时转移率为 6 6。总的敏感性为 6 6 % (16 9 2 5 5 ) ,特异性为 5 1% (131 2 5 5 )。结论 :CT对NSCLC患者肺门纵隔淋巴结转移具有较高的诊断价值 ,尤其淋巴结短径≥ 2 0mm时 ,CT检查的敏感性较高。影响CT准确性的因素有淋巴结大小以及患者是否伴有肿瘤引起的阻塞性肺炎或肺不张     

肺癌淋巴结隐匿性转移的基因诊断及预后研究

目的 探讨非小细胞肺癌（NSCLC）纵隔淋巴结隐匿性转移的基因诊断方法,并评价其对预后的意义。方法 应用逆转录聚合酶链反应（RT－PCR）技术,对37例pN0 NSCLC（Ⅰa-Ⅱb期）的168枚纵隔淋巴结标本中的黏蛋白1（MUC1）基因mRNA表达情况进行检测。对照组为同期经手术治疗的患者,其中阴性对照淋巴结30枚（取自14例肺良性病变）,阳性对照标本30个（15例NSCLC的肿瘤标本和病理诊断为转移癌的NSCLC纵隔淋巴结15枚）。通过x^2检验,比较预后差别。结果 阴性对照组均无MUC1 mRNA表达,特异度1005;阳性对照组30个标本中,26个有MUC1 mRNA表达,灵敏度86.7%。实验组中12例患者的16个标本有MUC1 mRNA表达,占9.5%,其TNM分期上调为Ⅲa。MUC1 mRNA表达阴性组3年生存率（88.0%）高于MUC1 mRNA阳性组（58.3%,P＜0.05）。结论 应用RT－PCR法检测MUC1 mRNA的表达可诊断肺癌纵隔淋巴结隐匿性转移;纵隔淋巴结隐匿性转移可能与pN0肺癌预后不良有关。     

非小细胞肺癌纵隔淋巴结转移(N2)的外科治疗选择

目的 探讨有纵隔淋巴结转移（N2）的非小细胞肺癌（NSCLC）的外科治疗选择。方法 回顾性分析总结325例N2 NSCLC的外科治疗效果和经验。结果 全组5年生存率为19．6％,其中根治性切除者高于姑息性切除者,鳞癌高于腺癌,行袖式肺叶切除和全肺切除者高于常规肺叶切除者,纵隔淋巴结转移1～3枚者高于〉3枚者,术后综合治疗者高于单一外科治疗者,上述差异均有统计学意义。所有T3、T4以及M1患者均无5年生存者。结论 对于N2 NSCLC肿瘤为Tl或T2、病理类型为非腺癌以及纵隔转移淋巴结〈4枚者,外科治疗是最好的选择。对于肿瘤为T3的患者,外科治疗可能并非良策,肿瘤的根治性切除以及肺门和纵隔的系统淋巴结清扫,是病变分期和生存率提高的关键所在,术后综合治疗有助于患者的远期生存,尤其适用于有肿瘤残留和（或）纵隔转移淋巴结〉3枚的患者。