Ⅲ期非小细胞肺癌纵隔淋巴结跳跃式转移的临床意义

目的探讨Ⅲ期非小细胞肺癌(NSCLC)患者纵隔淋巴结跳跃式转移的临床意义。方法65例术后病理证实的NSCLC患者,分为纵隔淋巴结(pN2期)跳跃转移组(21例)及非跳跃转移组(44例),回顾分析两组患者的临床、手术及病理资料。结果两组患者的性别、年龄及肿瘤的病理类型、大小、部位和术后转移情况差异无统计学意义(P均>0·05);非跳跃转移组发生多组淋巴结转移的概率为36.4%(16/44)显著高于跳跃转移组的9.5%(2/21;χ2=8·571,P=0·036)。跳跃转移组患者术后平均生存时间为44个月,5年生存率为41%;非跳跃转移组术后平均生存时间为26个月,5年生存率为21%,两者差异有统计学意义(χ2=9·325,P<0·05)。纵隔淋巴结跳跃式转移可以作为肺癌术后一个独立的预后因素(P=0·003,RR=0·347)。结论纵隔淋巴结跳跃式转移的临床Ⅲ期NSCLC患者生存期较无跳跃式转移的患者长,纵隔淋巴结跳跃式转移可以作为一个独立的生存预后因素;跳跃式转移可能是pN期肺癌中的一个亚群。

Skip metastasis to mediastinal lymph nodes: clinical significance and prognosis in stage Ⅲ non-small cell lung cancer

OBJECTIVE: To analyze the significance and prognosis of skip metastasis to mediastinal lymph nodes in stage III non-small cell lung cancer (NSCLC). METHODS: The data of 65 patients who underwent resection for NSCLC with a pN(2)-stage were analyzed retrospectively. Twenty-one of these patients (32.3%), showing no metastatic involvement of hilar (N(1)) lymph nodes, were compared to the remaining 44 patients with infiltration of hilar nodes (N(1)) as well as N(2) nodes. Software SPSS 10.0 was used for statistical analysis. RESULTS: Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N(2) group regarding sex, age, histology, location, and T-or M-status. In the skip metastasis group, mediastinal node metastasis was found in >or=2 region in 16 patients (36.4%) and in continuous N(2) group in 2 patients (9.5%, chi(2) = 8.571, P = 0.036). The 5-year survival rate of pN(2) patients with skip metastasis was 41% compared to 21% in patients with involvement of N(1) and N(2) nodes (P = 0.022 6), and the mean survival time was 44 months and 26 months respectively. CONCLUSIONS: pN(2) patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN(2) patients with continuous infiltration of the regional lymph nodes. Skip metastasis is an independent prognostic factor for survival. Skip metastasis may represent a subgroup of pN(2) classification.