cTNM-ⅠA期非小细胞肺癌肺门淋巴结转移的规律及临床意义

高雄; 唐震; 贡会源; 李伟; 张雷; 王彪

doi:10.16766/j.cnki.issn.1674-4152.002583

cTNM-ⅠA期非小细胞肺癌肺门淋巴结转移的规律及临床意义

doi: 10.16766/j.cnki.issn.1674-4152.002583

蚌埠医学院第一附属医院胸外科，安徽蚌埠 233004

基金项目:

安徽省中央引导地方科技发展项目 2020b07030008

详细信息

通讯作者:
唐震, E-mail: 15855776000@139.com

中图分类号: R734.2R730.2
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-22
- 网络出版日期: 2022-09-26

Exploration of the pattern of lung hilar lymph node metastasis in cTNM-stage IA non-small cell lung cancer and its clinical significance

Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨肺门淋巴结(第10组淋巴结)在cTNM-ⅠA期非小细胞肺癌(NSCLC)中的转移规律以及临床意义。方法回顾性分析2020年1月1日—2021年1月1日蚌埠医学院第一附属医院胸外科收治的233例原发性cTNM-ⅠA期NSCLC患者在接受肺叶切除和系统性淋巴结清扫术后的肿瘤及淋巴结病理情况。结果 233例患者共取得淋巴结3 145枚，平均每例13.5枚，440枚淋巴结存在癌转移，转移率为14.0%。233例患者中49例有胸内淋巴结转移，其中N₁有16例，N₁+N₂有25例[注：N₁为单纯肺内淋巴结存在转移；N₁+N₂为存在N₂(纵隔2~9组淋巴结)转移的同时，亦存在N₁(肺内第10~14组淋巴结)]，跳跃性N₂有8例，总转移率为21.0%(49/233)。其中N₁中第10组淋巴结阳性的有10例，占62.5%(10/16)，N₁+N₂中第10组淋巴结阳性的有18例，占72.0%(18/25)。第10组淋巴结转移率在T_1b期和T_1a期差异具有统计学意义(P < 0.05)，第10组淋巴结在低分化及中分化肺癌中的转移率分别为25.9%(21/81)和8.3%(7/84)，差异有统计学意义(χ²=9.060，P < 0.05)。结论 NSCLC中第10组淋巴结转移与原发肿瘤大小、临床病理类型、分化程度密切相关，在N₁、N₁+N₂、N₂存在淋巴结转移的情况下，第10组淋巴结阳性的概率较大；因此，早期非小细胞肺癌患者接受手术时优先对第10组淋巴结进行病理检测，根据第10组淋巴结病理情况，决定下一步手术方案更具有科学性。
- 淋巴结转移 /
- 非小细胞肺癌 /
- 肿瘤 /
- 病理学
Abstract: Objective To investigate the metastasis pattern of hilar lymph nodes (group 10 lymph nodes) in cTNM-ⅠA stage non-small cell lung cancer (NSCLC) and the clinical significance. Methods A retrospective analysis of tumor and lymph node pathology was performed in 233 patients with primary cTNM-stage Ⅰ NSCLC, who underwent lobectomy and systemic lymph node dissection from January 1, 2020 to January 1, 2021 in the thoracic surgery ward of the First Affiliated Hospital of Bengbu Medical College. Results A total of 3 145 lymph nodes were obtained from 233 patients, with an average of 13.5 lymph nodes per case, and 440 lymph nodes had cancer metastasis, with a metastasis rate of 14.0%. Among the 233 patients, 49 cases had intrathoracic lymph node metastasis, including 16 cases of N₁, 25 cases of N₁+N₂ [Note: N₁: metastasis of intrapulmonary lymph nodes alone; N₁+N₂: metastasis of N₂ (mediastinal group 2-9 lymph nodes) and N₁ (intrapulmonary group 10-14 lymph nodes) at the same time] and 8 cases of skipping status N₂, with a total metastasis rate of 21.0% (49/233). Among them, 10 cases were positive for group 10 lymph nodes in N₁, accounting for 62.5% (10/16), and 18 cases were positive for group 10 lymph nodes in N₁+N₂, accounting for 72.0% (18/25). The difference in metastasis rate of lymph nodes in group 10 was statistically significant between stage T_1b and stage T_1a (P < 0.05), and the metastasis rates of lymph nodes in group 10 in poorly and moderately differentiated lung cancer were 25.9% (21/81) and 8.3% (7/84), respectively, the difference was statistically significant (χ²=9.060, P < 0.05). Conclusion In NSCLC, group 10 lymph node metastasis is closely related to the primary tumor size, clinicopathological type and differentiation degree. In the case of lymph node metastasis in N₁, N₁+N₂ and N₂, the possibility of positive lymph node in group 10 is higher. Therefore, pathological detection of group 10 lymph nodes is a priority when NSCLC patients need a surgical operation, and it is more scientific to decide the subsequent surgical plan, depending on the pathological results.
- Lymphatic metastasis /
- Non-small cell lung /
- Neoplasm /
- Pathology

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表 1 233例cTNM-ⅠA期NSCLC患者淋巴结统计情况

Table 1. Lymph node statistics of 233 patients with cTNM- ⅠA NSCLC

淋巴结位置	阳性数/总采集数	阳性率(%)
2	27/186	14.5
3	8/130	6.2
4	35/178	19.7
5	29/397	7.3
6	28/305	9.2
7	72/325	22.2
8	8/101	7.9
9	15/270	5.6
10	113/531	21.3
11	57/360	15.8
12	38/265	14.3
13	10/97	10.3

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表 2 病理类型及分化程度与淋巴结转移的关系

Table 2. Relationship between pathological type, differentiation degree and lymph node metastasis

特征	例数	淋巴结阳性率(%)	χ²值	P值	第10组淋巴结阳性率(%)	χ²值	P值
病理类型
鳞癌	128	18.0(23/128)	1.601	0.214	17.7(17/96)	0.091	0.771
腺癌	105	24.8(26/105)			15.9(11/69)
分化程度
低分化	145	25.5(37/145)	4.662	0.033	25.9(21/81)	9.060	0.001
中分化	88	13.6(12/88)			8.3(7/84)
肿瘤位置
中央型	62	16.1(10/62)	1.220	0.271	4.4(2/45)	1.683	0.823
周围型	171	22.8(39/171)			21.7(26/120)

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表 3 非小细胞肺癌大小及外侵程度与淋巴结转移的关系

Table 3. Relationship between lymph node metastasis and size of non-small cell lung cancer

肿瘤大小	例数	N₀(例)	N₁(例)	N₁+N₂(例)	N₂(例)	淋巴结阳性率(%)	肺门淋巴结阳性率(%)
T_1a	120	103	8	7	1	14.1(17/120)	7.6(7/92)
T_1b	95	77	6	16	5	18.9(18/95)	25.4(15/59)
T_1c	18	4	2	2	2	77.8(14/18)	42.8(6/14)
T_1a+T_1b+T_1c	233	184	16	25	8	21.0(49/233)	17.0(28/165)
注：T_1a与T_1b肺门淋巴结阳性率比较，χ²=9.166，P=0.002；T_1b与T_1c肺门淋巴结阳性率比较，χ²=0.935，P=0.333。

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表 4 N₂淋巴结与第10组淋巴结关系(例)

Table 4. Relationship between N₂ lymph node and Group 10 lymph node (case)

10组	2组		3组		4组		5组		6组		7组		8组		9组
10组	+	-	+	-	+	-	+	-	+	-	+	-	+	-	+	-
+	8	14	0	1	8	13	6	15	4	14	1	0	0	0	0	0
-	3	208	24	208	4	208	4	208	7	208	24	208	25	208	25	208
χ²值	46.587				44.137		26.945		9.401
P值^a	0.001				0.001		0.001		0.002		0.107^b
注：^a为各组淋巴结均与第10组比较；^b为采用Fisher精确检验。

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