可手术非小细胞肺癌淋巴结转移特点及其临床意义

目的:分析可手术非小细胞肺癌（non-small cell lung cancer ，NSCLC ）区域淋巴结的转移特点，探讨其在手术淋巴结清扫范围的选择以及术后放射治疗靶区勾画中的意义。方法:回顾性分析浙江省肿瘤医院2005年1 月至2010年12月810 例NSCLC 患者的临床资料，分析区域各组淋巴结转移频度以及肿瘤原发病灶与区域淋巴结转移部位的相关性。结果:NSCLC 区域淋巴结转移与患者年龄、肿瘤大小、组织学类型及肿瘤部位相关（P 值分别为0.013、0.000、0.009 和0.000）。 不同肿瘤原发部位有不同的淋巴结易转移区域。结论:左肺原发肿瘤中病灶大、组织学类型为腺癌的患者易发生区域淋巴结转移。非小细胞肺癌在纵隔淋巴结的转移中，右上肺癌主要转移至上纵隔2～4 区；右中肺和右下肺癌主要转移至上纵隔2～4 区、隆突下；左上肺癌主要转移至上纵隔2～4 区、主动脉弓下；左下肺癌主要转移至动脉弓下及隆突下。在手术选择淋巴结清扫范围及术后放射治疗靶区勾画时应特别注意这些淋巴结转移频度较高的区域。 

Features of lymph node metastasis in resectable non-small cell lung cancer and their clinical significance

Objective: To analyze the characteristics of regional lymph node metastasis in patients with resectable non- small cell lung cancer (NSCLC) and assess its clinical significance in surgical mediastinal lymph dissection and the target volume definition of postoperative radiotherapy. Methods:We retrospectively reviewed810 patients with NSCLC, and analyzed the metastatic frequency of each regional lymph node station as well as the correlation between tumor location and regional lymph node metastases. Results: Re-gional lymph node metastases were significantly associated with the age of patients, histology, tumor size, and tumor location ( P=0.013, 0.000, 0.009 and 0.000, respectively). Conclusion:The younger patients with left lung adenocarcinomas and large tumor size tended to regional lymph node metastases. The trend of regional lymphatic drainage in the lobes of lung occurred differently. The prior location of involved regional lymph nodes in different lobes of the NSCLC patients was as follows: The station 2- 4 for right upper lobe tumors, the station 2- 4 and 7 for right middle lobe tumors and right lower lobe tumors, the station 5- 6 for left upper lobe tumors, and the station 5- 6 and 7 for left lower lobe tumors. We should pay more attention to the regions regarding the higher frequencies of lymph node metastases, when determining the extent of lymph node dissection or delineating the target volume of postoperative radiotherapy for NSCLC patients.