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。

Analysis in lymph node metastasis of non-small cell lung cancer

Background and purpose:Lung cancer lymph node metastasis is the most common metastatic pathways that affect staging and prognosis.Intrathoracic lymph node metastasis including hilus and mediastinum is one of important prognosis factors of lung cancer.The aim of this study was to analyze the characteristics of lymph node metastasis in non-small cell lung cancer(NSCLC) and to provide evidence for determining the range of lymph node dissection.Methods:Two hundred and five NSCLC patients underwent surgery were enrolled.Intrathoracic lymph nodes were compared in each group the frequency.Besides from the primary tumor site and pathological type point of view,lymph node metastasis rates and skip metastasis rates differences were compared.Results:Two hundred and five NSCLC patients with intrathoracic lymph node dissection in 977 lymph node groups,a total number of 3 577 lymph nodes,with an average of 17.4.Metastasis occurred in 220 groups,508 lymph nodes,and were all confirmed by pathological methods.Intrathoracic lymph node metastasis occurred in 98 patients,the transfer rate was 47.8%.Skip metastasis occurred in 35 cases,the transfer rate was 17.1%.The 4,5,7,10,11 groups had a higher frequency of lymph node metastasis.Compared with the next(middle) lobe,skip metastases occurred more likely in upper lobe lung cancer.In adenocarcinoma,lymph node metastasis was significantly higher than squamous cell carcinoma.Conclusion:The major mediastinal transfer of NSCLC is metastasizing between pulmonary lymph nodes and then to mediastinal lymph nodes in sequential order,which was usually occured to mediastinal lymph node directly.The transfer is closely related to the primary tumor site and type.The lymph node dissection should be based on the rule of intrathoracic lymph node metastasis.Doctors should pay more attention to the 4,5,7,10,11 group lymph nodes which are transferred frequently.