同时性多原发肺癌淋巴结转移规律的临床研究

目的 探讨多原发肺癌的诊疗手段及淋巴结转移情况。方法 回顾性分析2015年1月至2019年12月江门市中心医院胸外科收治的93例多原发肺癌病例,根据主病灶直径分为A组（≤10 mm）、B组（>10 mm,≤20 mm）和C组（>20 mm,≤30 mm）分析其年龄、吸烟史、肿瘤标记物和淋巴结转移情况等。结果 多原发肺癌随年龄递增,主病灶直径增大,而吸烟史与主病灶直径无关。A组CEA（2.00±1.80）μg/mL、Cyfra21-1（2.38±1.09）ng/mL与B组CEA（2.81±2.52）μg/mL、Cyfra21-1（2.53±0.76）ng/mL均在正常值内;但C组CEA（23.61±46.14）μg/mL与Cyfra21-1（3.54±1.31）ng/mL较A、B组均明显增高,差异有统计学意义（P<0.05）。A组中仅第10组淋巴结转移（5.26%）,而其他组淋巴结均未见转移;B组第10、11组淋巴结转移（6.90%、3.57%）,并有N2淋巴结转移,第5组淋巴结转移（16.67%）;C组N2淋巴结转移情况更多见,第2、4、7组淋巴结转移率分别为5.44%、4.60%和2.22%。不同类型肺癌淋巴结转移情况不同。肺结节位于一侧行同期肺结节切除,位于双侧则分期肺结节切除,间隔3~12月。1年PFS、OS均为100%。结论 多原发肺癌位于同侧行同期肺结节切除,位于双侧则分期肺结节切除,无严重并发症,安全性高。多原发肺癌主病灶直径≤1 cm时,建议行选择性淋巴结切除清扫或淋巴结取样（肺门淋巴结）;主病灶直径>1 cm时,则应行系统性淋巴结清扫。

Lymph node metastasis of simultaneous multiple primary lung cancer

Objective To investigate the diagnosis and treatment of multiple primary lung cancer and lymph node metastasis. Methods Ninety-three cases of multiple primary lung cancer from January 2015 to December 2019 were divided into A group （≤10）, B group （>10, ≤20） and C group （>20, ≤30） according to the diameter of the main lesion. The age, smoking history, tumor markers and lymph node metastasis in three groups were analyzed. Results Multiple primary lung cancers increase in diameter of the main lesion with age, while smoking history has nothing to do with the diameter of the main lesion. CEA （2.00±1.80）μg/mL, Cyfra 21-1 （2.38±1.09）ng/mL, CEA （2.00±1.09） in A group and CEA （2.81±2.52）μg/mL, Cyfra21-1 （2.53±0.76）ng/mL in B group were within the normal ranges. CEA （23.61±46.14）μg/mL and Cyfra21-1（3.54±1.31）ng/mL in C group were significantly higher than those of the A and B group （all P values < 0.05）. In A group, only No.10 lymph node had metastasis （5.26%）. No.10 （6.90%）, No.11 （3.57%）, No.5 （16.67%） lymph node had metastasis in B group. In C group, more lymph node had metastasis in N2 lymph node, and the lymph node metastasis rates were 5.44%, 4.60% and 2.22% in No.2, No.4 and No.7, respectively. Different types of lung cancer had different lymph node metastasis. Simultaneous resection of pulmonary nodules on one side, stage pulmonary resection of pulmonary nodule resection in different sides which interval 3 to 12 months. PFS, OS were 100% in 1 year. Conclusion Patients with multiple primary lung cancers on the same side can undergo simultaneous lung nodules resection, while on both sides, lung nodules can be removed by stages, all which has no serious complications and is highly safe. When the diameter of multiple primary lung cancer lesions is ≤ 1 cm, selective lymphadenectomy or lymph node sampling （hilar lymph nodes） is recommended. For those of lesions were greater than 1 cm, the systemic lymph node dissection should be done.