ⅢA-N2期非小细胞肺癌纵隔淋巴结跳跃式转移的临床和预后分析

目的 探讨ⅢA-N2期非小细胞肺癌(NSCLC)纵隔淋巴结跳跃式转移的临床病理特征和分布规律,并分析跳跃转移对生存期的影响.方法 回顾性分析2000年1月至2004年12月478例行手术并经病理证实的ⅢA-N2期非小细胞肺癌患者的临床资料,分为跳跃转移组和非跳跃转移组,分析两组的临床病理特征,N2分布情况以及对生存期的影响并进行统计学分析.结果 全组N2跳跃转移的发生率为40.6%,与性别和吸烟情况有关(χ2=5.340,p=0.021和χ2=7.143,P=0.008),且鳞状细胞癌易发生跳跃转移(χ2=7.602,P=0.022),上叶较下叶更易发生跳跃转移(χ2=5.097,P=0.024),上纵隔淋巴结区为跳跃转移好发区(χ2=7.046,P=0.030).跳跃转移时,右上肺癌易转移至2、3、4组淋巴结,右中和右下肺癌则易转移至7组淋巴结;左上肺癌时,71.7%的转移N2淋巴结位于5、6组淋巴结,而左下肺癌则较易转移至7、9组淋巴结.跳跃转移组5年生存率优于非跳跃转移组(22.1%比13.6%,P=0.001),生存分析显示,跳跃转移是影响N2患者生存期的独立因素.结论 在N2期NSCLC中,跳跃转移易发生于肺上叶以及上纵隔区.跳跃转移可作为ⅢA-N2期NSCLC的一个亚群,具有更高的生存率.

Clinical and prognostic analysis of skip N2 metastases in stage m A-N2 non-small cell lung cancer

Objective To investigate the clinicopathologic factors and the distribution pattern of N2 lymph nodes, to analyze the relationship between the survival rate and skip metastasis of non-small cell lung cancer(NSCLC) patients. Methods The clinical data of 478 patients with a pN2 stage who underwent resection for non-small cell lung cancer from January 2000 to December 2004 was retrospectively analyzed. Skip group and non-skip group were defined. Characteristics of tumors, ganglionar involvement and survival were analyzed in both groups. Results The incidence rate of skip N2 metastasis in stage M A-N2 NSCLC patients was 40. 6% , which was correlated to sex, smoking and the type of histology (P < 0. 05). Squamous carcinoma was the main type of skip group (χ2 = 7. 602, P = 0. 022 ). The frequency of skip metastasis was higher in patients with a primary tumor in the upper lobe (57% ) compared to the lower lobe (43% ) (χ2 = 5. 097, P = 0. 024). Superior nodes were more frequently involved by skip group (χ2 =7. 046, P = 0.030). Moreover, the relationship between the primary tumor location and N2 positive lymph nodes were described as follows; right upper lobe cancer displayed skip-N2 nodal metastasis mostly in the 2nd ,3nd and 4th station, right middle and lower lobe mostly in the 7th station, left upper lobe mostly in the 5th and 6th station (71. 7% ), and left lower lobe mostly in the 7th and 9th station. The 5-year survival rate of pN2 patients with skip metastasis was 22. 1% compared to 13.6% in patients with involvement of Nl and N2 nodes (P = 0. 001). Survival analysis showed that skip N2 metastasis was an independent risk factor of stage Ⅲ A NSCLC. Conclusions The frequency of skip metastasis was higher in patients with a primary tumor in the upper lobe and in the superior nodes. Skip metastasis is an independent prognostic factor of survival. The presence of skip metastasis seems to be a unique subgroup of pN2 disease in NSCLC.