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。     

Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer

Optimal surgical treatment for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) remains a matter of debate, because of the outcomes. The outcomes may be affected from variations in patterns of lymph node metastasis. As the patterns of lymph node sub-classifications, multiple station metastases of mediastinal lymph nodes (MN2), highest metastasis of the mediastinal lymph nodes (HM), distribution of metastatic nodes (skip N2 or non-skip N2), and clinical (c-) N factor have been cited. We investigated these factors for patients with pathological stage IIIA (pIIIA) N2 NSCLC. We reviewed 121 consecutive patients with pIIIA N2 who underwent complete resection. Age, gender, tumor laterality, histology, lobe location of the tumor, c-T factor, pathological (p-) T factor, c-N factor, MN2, HM and skip N2 condition were used as prognostic variables. Overall five-year survival rate was 41.8%. Based on log-rank testing, c-T factor (P = 0.022), p-T factor (P = 0.0002), c-N factor (P = 0.009), HM (P = 0.019) and skip N2 (P = 0.030) were identified as significantly prognostic. Using these variables, p-T factor, c-N factor and skip N2 showed significance and independence on Cox multivariate analysis. The sub-classification of lymph node metastasis in patients with p-stage IIIA N2 NSCLC has clinical implications for the prognosis.     

The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer

Background

The treatment of patients with nonsmall cell lung cancer (NSCLC) is determined by the stage. We evaluated the accuracy of staging using integrated positron emission tomography (PET) and computed tomography (CT) and compared it with dedicated PET visually correlated with CT scan.

Methods

A prospective blinded trial was performed on a consecutive series of patients with NSCLC. Patients underwent integrated PET-CT scanning with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-18). A radiologist assigned the T, N and M status. No sooner than 2 weeks the same radiologist read the dedicated PET alone, without the integrated CT images and a T, N and M status was assigned again. The most recent CT scan was available and visually correlated with both studies. All patients underwent biopsies of suspicious N2 or N3 lymph node or distant metastases and if negative, pulmonary resection with lymphadenectomy was performed.

Results

There were 129 patients. Integrated PET-CT is a better predictor than PET for all stages of cancer and achieved statistical significance for stage I (52% versus 33%, p = 0.03) and for stage II (70% versus 36%, p = 0.04). It also is a better overall predictor for T status (70% versus 47%, p = 0.001) and the N status (78% versus 56%, p = 0.008). Nodal analysis shows that integrated PET-CT was more accurate for the total N2 nodes (96% versus 93%, p = 0.01) and for the total N1 nodes (90% versus 80%, p = 0.001). It was also more sensitive, specific, and had a higher positive predictive value for both N2 and N1 nodes (p < 0.05 for all). Integrated PET-CT is significantly more sensitive at the 4R, 5, 7, 10L and 11 stations and more accurate at the 7 and 11 lymph nodes stations than dedicated PET.

Conclusions

Integrated PET-CT using FDG-18 better predicts stage I and II disease as well as the T and N status of patients with NSCLC when compared with dedicated PET alone. It is more accurate at some nodal stations but still only achieves an accuracy of 96% and 90% for the N2 and N1 nodes, respectively.     

The Prognosis of T3N0 Colon Cancer Is Dependent on the Number of Lymph Nodes Examined

Background: T3N0 colon cancer is the target of many adjuvant studies. Very few studies have examined the relationship of the number of lymph nodes examined to the prognosis of this stage. We examined data from the National Cancer Data Base (NCDB) to determine whether the number of examined lymph nodes is prognostic for T3N0 colon cancer.Methods: A total of 35,787 prospectively collected cases of T3N0 colon cancer that were surgically treated and pathologically reported from 1985 to 1991 to the NCDB as T3N0M0 were analyzed.Results: The 5-year relative survival rate for T3N0M0 colon cancer varied from 64% if 1 or 2 lymph nodes were examined to 86% if >25 lymph nodes were examined. Three strata of lymph nodes (1–7, 8–12, and 13) distinguished significantly different observed 5-year survival rates.Conclusions: These results demonstrate that the prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. A minimum of 13 lymph nodes should be examined to label a T3 colon cancer as node negative. These data suggest that adjuvant trials for T3N0 colon cancer should stratify according to the number of lymph nodes examined.Presented at the 54th Annual Meeting of the Society of Surgical Oncology, Washington, DC, March 17, 2001     

非小细胞肺癌1638例治疗及预后探讨

目的 结合2009 TNM分期和患者临床资料分析探讨非小细胞肺痛的预后及其影响因素.方法 回顾性分析2001年1月至2005年1月接受手术的1638例非小细胞肺癌患者的临床资料,并对其预后及影响其预后的临床病理因素进行分析.其中男性1083例,女性555例,平均年龄59.5岁.结果 非小细胞肺癌患者术后总体1年、3年及5年生存率分别为80.0%、52.3%及39.0%.单因素分析显示影响预后的因素为支气管断端是否阳性、手术方式、T分期、N分期、淋巴结清扫个数(0～、10～及＞20个)、淋巴结清扫组数和术后放疗(P＜0.05).Cox回归多因素分析提示,手术方式(P=0.001)、T分期(P=0.000)、N分期(P=0.000)和淋巴结清扫个数(P=0.013)是独立的预后影响因素.结论 非小细胞肺癌总体预后差.手术方式、T分期、N分期及淋巴结清扫个数均是其预后的独立影响因素.

Abstract：

Objective To study the prognosis and prognostic factors of non-small-cell lung carcinoma(NSCLC)according the new TNM stage system.Methods Clinic data of 1638 inpatient cases admitted from January 2001 to January 2005 were retrospectively reviewed.There were 1083 male and 555 female patients in the study and the average age was 59.5 years.All the patients received surgical procedures.Results The overall 1,3,5-year survival rate was 80.0%,52.3%,39.0%.The main prognostic factors were bronchial stump,operation type,T stage,N stage,the number of lymph nodes (LNs)in lymph nodes dissection(1-10,11-20,and＞20),overall N stations(＜4 and ≥4)and postoperative radiotherapy(all P＜0.05).Cox regression suggested that T stage(P = 0.000),N stage (P=0.000),operation type(P=0.001)and LNs(P = 0.013)were independent factors affecting the prognosis.Conclusions The overall survival rate of NSCLC is poor.T stage,N stage,operation type and LNs are independent factors affecting the prognosis.     

Impact of main bronchial lymph node involvement in pathological T1-2N1M0 non-small-cell lung cancer: multi-institutional survey by the Japan National Hospital Study Group for Lung Cancer

Purpose  

According to the TNM classification revised in 1997, stage II non-small-cell lung cancer (NSCLC) has an unfavorable prognosis. The purpose of this study was to analyze the prognostic factors for pathological T1-2N1M0 patients with NSCLC and elucidate the significance of main bronchial lymph nodes involvement.     

Intrapulmonary lymph nodes detected by exploratory video-assisted thoracoscopic surgery: appearance of helical computed tomography.

The objective of this study was to analyze helical computed tomography (CT) findings of intrapulmonary lymph nodes (IPLNs), and to evaluate the diagnostic procedures to prevent unnecessary exploratory surgery. Between April 1997 and March 2000, we performed exploratory video-assisted thoracoscopic surgery (E-VATS) in 42 patients and in 8 patients (4 men, 4 women; 48 to 75 years of age, mean 57 years) IPLN was pathologically proven. Retrospectively, the appearances of IPLN in helical CT images were studied in detail. The diameter of the IPLNs varied from 4 to 10mm. Six nodules were located in the lower lobes and 2 nodule was in the lingula. Chest CT showed several malignancy-suggesting associated findings with pleural indentation (2/8), spicular radiation (2/8), fuzzy margins (4/8), and vascular involvement (2/8). Black colored anthracoses in 5 subpleural IPLNs were confirmed by thoracoscopy. One patient with two coin lesions was suggestive of lung metastasis of adenoidcystic carcinoma of the tongue, but one lesion was proven as IPLN, and the other as metastatic carcinoma. In conclusion, it is not possible to distinguish an intrapulmonary lymph node from a malignant lesion using the CT findings preoperatively. Therefore, a pathological study with E-VATS is necessary and sure procedure to exclude malignant disease under the present conditions.     

肺内淋巴结精准取材对肺癌患者术后N分期的影响

目的探讨非小细胞肺癌(NSCLC)患者肺内淋巴结转移情况及其对病理分期的影响。 方法选取2015年1月1日至2016年3月31日期间在天津市胸科医院胸外科接受肺叶或全肺切除及系统性淋巴结清扫术的177例肺癌患者进行分析。首先按照外科医师清扫的淋巴结常规取材进行病理诊断,得出N分期;由病理科医师再对第12、13组淋巴结进行分检精准取材,得出一个新的N分期,比较并分析前后两个N分期的差异。同时,进一步分析这两组淋巴结转移的危险因素。 结果全组患者共检出N1站淋巴结1 268枚,常规取材(第10、11组淋巴结)共检出736枚,精准取材(第12、13组淋巴结)共检出532枚。联合NSCLC的常规取材和肺内淋巴结的精准取材,患者的N1淋巴结检出的中位数为7枚(2～24枚),与NSCLC的常规取材相差4枚(0～18枚),N1淋巴结的检出数明显增加(P<0.001)。联合NSCLC的常规取材和肺内淋巴结的精准取材,共检出转移N1淋巴结240枚,中位转移数量为0枚(区间：0～7枚;第75百分位数：1枚;第90百分位数：3枚),与NSCLC的常规取材相比(区间：0～5枚;第75百分位数：0枚;第90百分位数：2枚),N1淋巴结的转移个数明显增加(P<0.001)。分层分析结果显示：第12、13组淋巴结的转移与手术方式、手术部位、病理类型、肿瘤大小以及纵隔淋巴结转移存在一定相关性(P<0.05),但与患者的年龄、性别以及术后病理是否存在脉管癌栓无明显相关性(P>0.05)。有15例患者的N分期由于肺内淋巴结的精准取材由N0升为N1,占全组患者的8.4%。 结论常规NSCLC取材方式容易漏检N1区域的淋巴结,并且相当一部分还是转移淋巴结。因此,提倡NSCLC肺内淋巴结精准取材以提高病理分期的准确性。     

Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET)

BACKGROUND: A study was undertaken to investigate the accuracy of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D- glucose (FDG) in the thoracic lymph node staging of non-small cell lung cancer (NSCLC). METHODS: Forty six patients with focal pulmonary tumours who underwent preoperative computed tomographic (CT) and FDG- PET scanning were evaluated retrospectively. Thirty two patients had NSCLC and 14 patients had a benign process. The final diagnosis was established by means of histopathological examination at thoracotomy, and the nodal classification in patients with lung cancer was performed by thorough dissection of the mediastinal nodes at surgery. RESULTS: FDG-PET was 80% sensitive, 100% specific, and 87.5% accurate in staging thoracic lymph nodes in patients with NSCLC, whereas CT scanning was 50% sensitive, 75% specific, and 59.4% accurate. The absence of lymph node tumour involvement was identified by FDG-PET in all 12 patients with NO disease compared with nine by CT scanning. Lymph node metastases were correctly detected by FDG-PET in three of five patients with N1 disease compared with two by CT scanning, in nine of 11 with N2 disease compared with six by CT scanning, an in all four with N3 nodes compared with two by CT scanning. CONCLUSIONS: FDG-PET provides a new and effective method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to resectability, FDG-PET could differentiate reliably between patients with N1/N2 disease and those with unresectable N3 disease.     

The impact on the prognosis of unsuspected N2 disease in non-small-cell lung cancer: indications for thorough mediastinal staging in the modern era

Purpose

Predicting the prognosis of advanced non-small-cell lung cancer (NSCLC) patients who present with clinically unsuspected N2 is very different due to the heterogeneity of this cohort. Thus, this study was undertaken to identify the clinicopathological features and survival of patients with clinical N0 or N1 and pathological N2, namely, unsuspected N2.

Methods

Among 239 patients with pathological N2 NSCLC, we reviewed the cases of 92 (38.5 %) patients who showed unsuspected N2. The prognosis was investigated using the Kaplan–Meier method and a Cox regression model.

Results

The 5-year overall survival (5yOS) of the patients with unsuspected N2 was 51.2 %. Based on a multivariate analysis, age and 18F-fluorodeoxyglucose (FDG) uptake in the lymph nodes were significant prognostic factors of unsuspected N2 (p = 0.0081, 0.0228, respectively). The 5yOS of PET-negative unsuspected N2 (n = 68) was 58.9 %, whereas that of PET-positive unsuspected N2 (n = 24) was 29.7 % (p = 0.0026). Furthermore, the 5yOS of PET-negative unsuspected N2 was significantly better than that of both clinical and pathological N2 s (i.e., suspected N2; n = 60; 5yOS, 42.1 %; p = 0.0051), while no significant difference was observed between PET-positive unsuspected N2 and suspected N2 (p = 0.6325).

Conclusions

A preoperative evaluation of the lymph nodes by PET/CT has a potential benefit in predicting the prognosis. A thorough evaluation of the lymph nodes is, therefore, needed if the lymph nodes show an FDG uptake, even in cases that show a clinical N0 status on thin section CT scans.

     

Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group

BACKGROUND: Mediastinal lymph node dissection (MLND) is an integral part of surgery for non-small cell lung cancer (NSCLC). To compare the impact of systematic sampling (SS) and complete MLND on the identification of mediastinal lymph node metastases and patient survival, the Eastern Cooperative Oncology Group (ECOG) stratified patients by type of MLND before participation in ECOG 3590 (a randomized prospective trial of adjuvant therapy in patients with completely resected stages II and IIIa NSCLC). METHODS: Eligibility requirements for study entry included a thorough investigation of the mediastinal lymph nodes with either SS or complete MLND. The former was defined as removal of at least one lymph node at levels 4, 7, and 10 during a right thoracotomy and at levels 5 and/or 6 and 7 during a left thoracotomy, while the latter required complete removal of all lymph nodes at those levels. RESULTS: Three hundred seventy-three eligible patients were accrued to the study. Among the 187 patients who underwent SS, N1 disease was identified in 40% and N2 disease in 60%. This was not significantly different than the 41% of N1 disease and 59% of N2 disease found among the 186 patients who underwent complete MLND. Among the 222 patients with N2 metastases, multiple levels of N2 disease were documented in 30% of patients who underwent complete MLND and in 12% of patients who had SS (p = 0.001). Median survival was 57.5 months for those patients who had undergone complete MLND and 29.2 months for those patients who had SS (p = 0.004). However, the survival advantage was limited to patients with right lung tumors (66.4 months vs 24.5 months, p<0.001). CONCLUSIONS: In this nonrandomized comparison, SS was as efficacious as complete MLND in staging patients with NSCLC. However, complete MLND identified significantly more levels of N2 disease. Furthermore, complete MLND was associated with improved survival with right NSCLC when compared with SS.     

手术切除的T4卫星灶非小细胞肺癌的预后分析

目的 研究手术治疗后T4卫星灶非小细胞肺癌的生存和预后.方法 回顾性分析1995年1月至2005年3月经手术切除的42例T4卫星灶N0-2M0非小细胞肺癌患者的术后生存情况,评价各临床病理因素与预后的关系,并与同期32例手术切除的T4局部器官侵犯N0-2M0的非小细胞肺癌进行生存比较.结果 T4卫星灶组无手术死亡,术后早期并发症率为14.3%,1、3、5年生存率分别为76.2%、57.1%和46.0%;T4局部器官侵犯组术后早期并发症率为28.1%,1、3、5年生存率分别为62.3%、31.5%和20.0%;两组生存率有明显差异(P<0.05).根据淋巴结转移情况进一步分组,两组中N0M0患者的生存率均高于同组的N1-2M0患者(P<0.05).单因素分析显示,组织学类型、原发灶大小、有无淋巴结转移及是否术后辅助化疗与T4卫星灶患者的5年生存率相关;多因素分析显示原发灶大小、有无淋巴结转移及是否接受术后化疗是独立的预后影响因素.结论 原发灶直径3 cm、淋巴结转移以及未接受术后化疗的T4卫星灶非小细胞肺癌预后不佳,经手术完全切除的T4卫星灶非小细胞肺癌的预后好于T4局部器官侵犯者.     

Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer

BACKGROUND: Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Nodal micrometastases may not be detected. Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. We performed intraoperative Technetium 99m sentinel lymph node (SN) mapping in patients with resectable NSCLC. METHODS: Fifty-two patients (31 men, 21 women) with resectable suspected NSCLC were enrolled. At thoracotomy, the primary tumor was injected with 2 mCi Tc-99. After dissection, scintographic readings of both the primary tumor and lymph nodes were obtained with a handheld gamma counter. Resection with mediastinal node dissection was performed and findings were correlated with histologic examination. RESULTS: Seven of the 52 patients did not have NSCLC (5 benign lesions, and 2 metastatic tumors) and were excluded. Forty-five patients had NSCLC completely resected. Mean time from injection of the radionucleide to identification of sentinel nodes was 63 minutes (range 23 to 170). Thirty-seven patients (82%) had a SN identified; 12 (32%) had metastatic disease. 35 of the 37 SNs (94%) were classified as true positive with no metastases found in other intrathoracic lymph nodes without concurrent SN involvement. Two inaccurately identified SNs were encountered (5%). SNs were mediastinal (N2) in 8 patients (22%). CONCLUSIONS: Intraoperative SN mapping with Tc-99 is an accurate way to identify the first site of potential nodal metastases of NSCLC. This method may improve the precision of pathologic staging and limit the need for mediastinal node dissection in selected patients.     

非小细胞肺癌淋巴结微转移的临床病理研究

目的 探讨免疫组化染色检测非小细胞肺癌淋巴结微转移的可行性。方法 将25例肺癌患者术中获取的淋巴结标本进行石蜡包埋,然后连续切片,6～10张不等,切片厚为5μm。选择第1和倒数第2张切片进行苏木精伊红染色,剩余切片用于免疫组化染色。免疫组化所选抗体为鼠抗人细胞角蛋白19单克隆抗体。结果 195枚淋巴结接受了苏木精伊红染色检查。9例患者共30枚淋巴结中发现有显性转移,无一例患者的淋巴结中检测出微转移。135枚苏木精伊红染色阴性的淋巴结又进行了免疫组化染色检查,有31枚淋巴结病理切片中显现出了癌微转移。16例常规病理PN0期患者中,5例患者肺门淋巴结出现了微转移;另9例常规病理PN1期患者中,4例出现了纵隔淋巴结的微转移,差异有统计学意义（x^2=52．900,P=0．0193）。结论 普通苏木精伊红染色能准确地检测出非小细胞肺癌淋巴结中的显性转移灶,而不易发现隐匿性微转移灶。免疫组化染色能提高非小细胞肺癌淋巴结微转移的检出率,并可对部分Ⅰ、Ⅱ期患者重新进行TNN分期。     

Pneumonectomy vs lobectomy in the treatment of pathologic N1 NSCLC: could the type of surgical resection dictate survival?

AIM: To define the prognostic significance of specific types of N1 lymph node involvement in patients operated on for stage II (N1) NSCLC and to evaluate if the extent of resection affects survival. METHODS: Of 1117 patients operated on from 1985 to 1998, an homogeneous group of 124 consecutive patients with pathologic T1-T2 N1 disease who had undergone a complete resection with systematic nodal dissection were analysed. No patients received adjuvant radio- or chemotherapy. RESULTS: The overall 5-year survival rate was 48.8%. Survival was not related to pathologic T factor, histology, number, percentage or level of N1 involved, visceral pleura involvement, number of lymph nodes dissected. Patients were then divided into 3 groups depending on the level of lymph node involvement (stations 10, 11 and 12-13) and survival analysed according to the extent of resection (pneumonectomy vs lobectomy). No significant difference was found, however, in the group of level 10, patients treated by pneumonectomy showed a better 5-year survival (58%) compared to patients treated by lobectomy (33%) with a median survival of 110 against 58 months. This data was confirmed by a lower incidence of local recurrence in the pneumonectomy group than lobectomy group (0% vs 24%), whereas the same incidence of distant metastases was observed in the two groups (29% vs 23%). CONCLUSIONS: In patients with stage II (N1) NSCLC, only in case of station 10 involved, pneumonectomy could allow a better survival lowering the incidence of local recurrence. However the major part of patients with stage II (N1) NSCLC die for distant metastasis. This supports the necessity to develop a specific systemic treatment.     

ⅢA-N2期非小细胞肺癌切除术后影响预后的因素分析

目的 分析ⅢA-N2期非小细胞肺癌患者的临床情况和影响预后的相关因素,探讨手术及辅助治疗对预后的影响.方法 回顾性分析2000年1月至2005年12月经手术治疗的657例ⅢA-N2期非小细胞肺癌患者的临床资料,应用Kaplan-Meier法进行生存分析.单因素分析各变量与预后的关系采用Log-rank检验,多因素分析采用Cox模型.结果 术后全组患者的l、3和5年累计生存率分别为64.4%、26.0%和17.9%,中位生存期18个月.单因素分析中,影响生存期的不利因素为:肿瘤最大径>3 cm,高T分期,N2淋巴结无跳跃转移,纵隔淋巴结阳性数>4个,隆突下淋巴结阳性,治疗方式(单纯手术预后差,患者术后联合放化疗优于术后单纯化疗),术后未放疗、化疗,化疗周期小于4个.多因素分析显示,肿瘤直径(P=0.001),隆突下淋巴结阳性(P=0.019),纵隔淋巴结转移个数(P=0.006),术后化疗周期(P=0.007),术后放疗(P=0.055)和术后放化疗(P=0.026)对预后有明显影响.结论 ⅢA-N2期非小细胞肺癌患者5年生存率低,肿瘤直径、隆突下淋巴结阳性、纵隔淋巴结转移个数、术后化疗周期、术后联合放化疗是影响预后的独立因素.术后单站和多站纵隔淋巴结转移的预后相似,影响预后的主要是纵隔淋巴结的阳性个数,术后联合放化疗优于术后单纯化疗.     

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。     

The role of FDG-PET scan in staging patients with nonsmall cell carcinoma

BACKGROUND: To assess the role of flourodeoxyglucose-positron-emission tomography (FDG-PET) scan in staging patients with nonsmall cell lung cancer (NSCLC). METHODS: We prospectively studied 400 patients with NSCLC. Each patient underwent a computed tomography (CT) scan of the chest and upper abdomen, other conventional staging studies and had a FDG-PET scan within 1 month before surgery. All suspicious N2 lymph nodes by either chest CT or by FDG-PET scan were biopsied. Patients that were N2 and M1 negative underwent pulmonary resection and complete thoracic lymphadenectomy. RESULTS: The FDG-PET had a higher sensitivity (71% vs 43%, p < 0.001), positive predictive value (44% vs 31%, p < 0.001), negative predictive value (91% vs 84%, p = 0.006), and accuracy (76% vs 68%, p = 0.037) than CT scan for N2 lymph nodes. Similarly, FDG-PET had a higher sensitivity (67% vs 41%, p < 0.001), but lower specificity (78% vs 88%, p = 0.009) than CT scan for N1 lymph nodes. FDG-PET led to unnecessary mediastinoscopy in 38 patients. FDG-PET was most commonly falsely negative in the subcarinal (#7) station and the aortopulmonary window lymph node (#5, #6) stations. It accurately upstaged 28 patients (7%) with unsuspected metastasis and it accurately downstaged 23 patients (6%). CONCLUSIONS:The FDG-PET scan allows for improved patient selection. It more accurately stages the mediastinum, however there are many false positives lymph nodes and it may be more likely to miss N2 disease in the #5, #6, and #7 stations. A positive FDG-PET scan means a tissue biopsy is indicated in that location.     

Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei （PM） infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results （1） The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture. All the 12 cases （100%） had irregular fever （38-41℃） and enlarged lymph nodes, 8 cases （66%） had skin rashes; 8 cases （66%） had hepatomegaly; 9 cases （75%） had splenomegaly while 8 cases （66%） had anemia. （2） Imaging manifestation： Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 cases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung, and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS （CD4 T lymphocytes 〈50/μ L） with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver, spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of ＂cakes＂.     

Outcome of Surgical Resection as a First Line Therapy in T3 Non-small Cell Lung Cancer Patients

Background

The T3 category of the 7th Edition of the TNM classification of non-small cell lung cancer (NSCLC) has added two factors that do not appear in the 6th Edition, large tumor size (>7 cm) and pulmonary metastasis of the same lobe. These factors are considered to have different biological and clinical features. In the present study we assessed the outcome of surgical resection as a first line therapy for T3 NSCLC.

Methods

A total of 145 patients who were diagnosed according to the TNM 7th Edition with pathologic T3 NSCLC received surgical resection in our institution as a first line treatment. The outcomes of their treatment were analyzed.

Results

The 5-year survival rate was 46.9 %. On the basis of the 6th TNM Edition, the 5-year survival rate was 63.1 % for patients diagnosed with T2 disease (large tumor size), 44.3 % for patients diagnosed with T3 disease, and 33.1 % for patients diagnosed with T4 disease (pulmonary metastasis of the same lobe). There were no significant correlations between these categories and overall survival (OS). Nevertheless, 6th Edition T factors were found to be significantly correlated with lymph node status (p < 0.01). The univariate analyses showed that age, lymph node metastasis, and curative resection had significant effects on OS. In addition, the multivariate analysis identified age and N factor as independent prognostic factors in this cohort.

Conclusions

Indications for surgical resection as a first line therapy in T3 NSCLC should be based on N factors and patient age. Lymph node metastasis, especially N2 disease, was increasingly frequent in patients with 6th Edition T classifications.