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。

T1, T2 squamous or adenocarcinoma of the lung:characteristics of lymph node metastasis and its clinical significance

OBJECTIVES: To investigate the frequency, distribution and features of lymph node metastasis in T(1)/T(2) squamous or adenocarcinoma of the lung, and to provide evidence for extensive dissection of lymph nodes. METHODS: 254 patients with T(1)/T(2) squamous or adenocarcinoma of the lung underwent R2 surgery plus extensive dissection of hilar, interlobular and mediastinal lymph nodes according to the grouping system proposed by Naruke. RESULTS: 1 685 groups of lymph nodes were dissected. The metastatic rates of N(1) and N(2) was 20.0% and 10.2% respectively. Significant difference existed between T(1) and T(2) tumors (P < 0.01). No N(2) metastasis was found in T(1) squamous cell carcinoma. N(2) metastatic rates were 22.0% in squamous cell carcinoma and 40.9% in adenocarcinoma (P < 0.01). 64.3% of squamous carcinoma spread to only one group of N(2) nodes, and over 3 groups of lymph nodes were positive in 46.2% of adenocarcinoma. Saltatory metastasis accounted for 57.5% of N(2) metastasis. 13.6% of N(2)-positive tumors in upper lobes metastasized to the lower mediastinum, whereas 51.6% of N(2)-positive cancers in the lower lobes spread to the upper mediastinum. CONCLUSIONS: The frequency of lymph nodes metastasis increases with the growth of tumors. Metastasis in adenocarcinoma occurs more frequently than in squamous carcinoma. Tumor at any site can metastasize to the distant mediastinum. Except for T(1) squamous cancer, radical surgery can be achieved only by extensive dissection of ipsilateral intrapulmonary and mediastinal lymph nodes.