pN0期非小细胞肺癌淋巴结微转移的临床分析

目的：研究pN0期非小细胞肺癌（non-small cell lung cancer,NSCLC）淋巴结微转移的临床病理特征,并分析微转移与患者生存率的关系。方法：收集89例行肺癌根治术并经病理检查证实为pN0期NSCLC患者的淋巴结石蜡切片,使用抗细胞角蛋白抗体检测微转移,分析淋巴结微转移的临床病理特点及其与患者生存率的关系。结果：pN0期NSCLC淋巴结微转移率为18.0%,其与肿瘤部位（P=0.030）、T分期（P=0.041）有关;N1区域淋巴结微转移度高于N2区域淋巴结（P=0.024）,N2区域淋巴结跳跃性微转移率为5.62%;淋巴结微转移患者5年生存率低于无转移者（P=0.036）。生存分析显示淋巴结微转移是pN0期NSCLC的独立危险因素。结论：pN0期NSCLC的淋巴结微转移率较高,并可出现跳跃性微转移。术中应重视肺门、纵隔淋巴结清扫。淋巴结微转移预示pN0期NSCLC患者预后不良。

Clinical Analysis of Lymph Nodal Micrometastasis in Stage pN0 Non-small Cell Lung Cancer

Objective：This study was to investigate the clinicopathologic features of lymph nodal micrometastasis in stage pN0 non-small cell lung cancer（NSCLC） and to analyze the relationship between the survival rate and micrometastasis.Methods： Paraffin sections of hilum and mediastinal lymph nodes from 89 stage pN0 NSCLC patients,who underwent radical surgical resection in our Hospital were collected,and micrometastasis in them were detected by using anti-CK antibody AE1 /AE3.Clinicopathologic features of lymph nodal micrometastasis and survival were analyzed respectively.Results： The incidence rate of lymph nodal micrometastasis in stage pN0 NSCLC patients was 18.0%,which was correlated to tumor location （P=0.30） and T stage of the tumor（P=0.041）.There was a higher detection rate of micrometastasis in N1 regional lymph nodes than in N2 regional lymph nodes in which the incidence rate of skip N2 micrometastasis was 5.62%（P=0.024）.Moreover,the 5-year survival rate of patients with lymph nodal micrometastasis was significantly lower than those without micrometastasis（P=0.036）.Survival analysis showed that lymph nodal micrometastasis was a independent risk factor of stage pN0 NSCLC.Conclusions： The incidence rate of lymph nodal micrometastasis in stage pN0 NSCLC patients is high,moreover,skip N2 microetastases can be found in patients,which needs to undergo hilum and mediastinal nodal dissection.Micrometastasis patients with lymph nodal micrometastasis have a adverse prognosis.