切换至 "中华医学电子期刊资源库"
高级检索
中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2015, Vol. 02 ›› Issue (01) : 29 -34. doi: 10.3877/cma.j.issn.2095-8773.2015.01.006

所属专题： 文献；

论著

临床T1aN0M0肺腺癌淋巴结转移预测因素分析
叶波1, 曹克坚1, 范利民1, 杨骏1, 胡定中1, 施建新1, 李志刚1, 方文涛1, 赵珩1,†(), 陈海泉1   
  1. 1. 200030　上海交通大学附属胸科医院胸外科
  • 收稿日期:2014-11-02 出版日期:2015-02-28
  • 通信作者: 赵珩
  • 基金资助:
    上海市卫生局局级青年课题(20134y126)

Factors predicting lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas

Bo Ye1, Kejian Cao1, Limin Fan1, Jun Yang1, Dingzhong Hu1, Jianxin Shi1, Zhigang Li1, Wentao Fang1, Heng Zhao1,†(), Haiquan Chen1   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2014-11-02 Published:2015-02-28
  • Corresponding author: Heng Zhao
  • About author:
    Corresponding author: Zhao Heng, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

叶波, 曹克坚, 范利民, 杨骏, 胡定中, 施建新, 李志刚, 方文涛, 赵珩, 陈海泉. 临床T1aN0M0肺腺癌淋巴结转移预测因素分析[J/OL]. 中华胸部外科电子杂志, 2015, 02(01): 29-34.

Bo Ye, Kejian Cao, Limin Fan, Jun Yang, Dingzhong Hu, Jianxin Shi, Zhigang Li, Wentao Fang, Heng Zhao, Haiquan Chen. Factors predicting lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 29-34.

目的

分析T1aN0M0肺腺癌患者淋巴结转移的危险因素。

方法

在上海市胸科医院2011年1月至2012年12月行连续手术切除的5312例非小细胞肺癌患者中，选择273例临床分期为T1aN0M0肺腺癌的患者进行回顾性分析。根据CT检查结果分为纯磨玻璃影(GGO)、GGO带有实性成分(实性成分直径<5mm)、部分实性结节(实性成分直径≥5mm)及纯实性结节。对相关的临床资料及病理特征进行单因素和多因素分析，寻找淋巴结转移的高危因素。

结果

入选的273例患者均行薄层CT扫描，其中103例(37.7%)为纯GGO，118例(43.2%)为GGO带有实性成分(实性成分直径<5mm)，13例(4.8%)为部分实性结节(实性成分直径≥5mm)，39例(14.3%)为纯实性结节。共有18例(6.6%)患者有淋巴结转移，N1和N2淋巴结转移者分别为11例(6.5%)和7例(4.1%)。所有纯GGO及实性成分直径<5mm的患者术后均无淋巴结转移。多因素分析显示T1a肺腺癌患者淋巴结转移的危险因素为有症状、实性成分直径≥5mm以及癌胚抗原(CEA)水平增高者(CEA>5ng/ml)。多因素分析也显示纯实性结节的淋巴结转移因素为空气支气管征、肿瘤大小、有症状出现以及CEA水平增高者(95%CI：2.001～5.990，P＝0.035；95%CI：1.000～3.980，P＝0.021；95%CI：1.887～2.663，P＝0.020；95%CI：1.514～8.498，P＝0.013)。

结论

临床分期为T1aN0M0的肺腺癌患者，如果影像学表现为实性成分直径<5mm或表现为纯GGO者无淋巴结转移，应避免淋巴结清扫。但是对于临床上纯实性结节或者实性部分直径>5mm者，特别是CEA>5ng/ml或者出现临床症状者，应该行系统性淋巴结清扫。

关键词: 淋巴结, 肺腺癌, 癌，非小细胞肺, 临床分期
Objective

To determine the risk factors of lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas.

Methods

Among a consecutive of 5312 patients with non-small lung cancer undergoing surgical resection at Shanghai Chest Hospital between January 2011 and December 2012, the clinical records of 273 patients with clinical stage T1aN0M0 lung adenocarcinomas were retrospectively analysed. Preoperative CT categorized the tumors of 273 patients as pure ground glass opacity(GGO), GGO with minimal solid components (diameter of solid part<5mm), part-solid (diameter of solid parts≥5mm) and pure solid. Relevant clinicopathologic features were investigated to identify the risk factors of lymph node metastasis using univariate and multivariate analysis.

Results

Thin-section CT was performed among all the 273 patients, among whom 103 (37.7%) were pure GGO, 118 (43.2%) GGO with minimal solid components(diameter of solid part<5 mm), 13 (4.8%) part-solid (diameter of solid parts≥5mm), and the other 39 (14.3%) pure solid. There were 18 (6.6%) patients with lymph node metastasis. The incidences of N1 and N2 nodal involvement were 6.5% (11 patients) and 4.1% (7 patients), respectively. No lymph node metastasis occurred in patients with pure GGO and GGO with minimal solid components (diameter of solid part<5mm). Multivariate analysis indicated that symptoms at presentation, diameter of solid parts≥5mm and increased carcinoembryonic antigen (CEA) titer were risk factors of lymph node metastasis of T1a lung adenocarcinomas. Multivariate analysis also revealed that air bronchogram sign, tumor size, symptoms at presentation and increased abnormal CEA titer were risk factors of lymph node metastasis of pure solid tumors (95%CI: 2.001-5.990, P=0.035; 95%CI: 1.000-3.980, P=0.021; 95%CI: 1.887-2.663, P=0.020; 95%CI: 1.514-8.498, P=0.013).

Conclusions

Lymph node dissection should not be performed among patients of clinical stage T1aN0M0 lung adenocarcinomas with GGO with minimal solid components (diameter of solid part<5 mm), or among pure GGO with no lymph node metastasis. However, systematic lymph node dissection should be performed for pure solid tumors or part-solid, especially in patients with CEA >5ng/ml or symptoms at presentation.

Key words: Lymph node, Lung adenocarcinomas, Carcinoma, non-small cell lung, Clinical stage
表1 273例临床分期T1aN0M0肺腺癌患者的淋巴结转移单因素分析
变量 例数 临床分期 χ 2/F值 P值
pN0(255例) pN1(11例) pN2(7例)
年龄 ? ? ? ? 0.631 0.643
? ≤59岁 112 103 6 3 ? ?
? >59岁 161 152 5 4 ? ?
性别 ? ? ? ? 2.142 0.857
? 女性 145 136 5 4 ? ?
? 男性 128 119 6 3 ? ?
吸烟史 ? ? ? ? 0.231 0.916
? 无 164 154 6 4 ? ?
? 有 109 101 5 3 ? ?
症状 ? ? ? ? 0.645 0.001
? 无 228 218 5 5 ? ?
? 有 45 37 6 2 ? ?
肿瘤直径 ? ? ? ? 9.081 0.854
? <1.0cm 59 56 2 1 ? ?
? 1.0～2.0cm 214 199 9 6 ? ?
小结节的影像学表现 ? ? ? ? 22.51* 0.000
? 纯GGO 103 103 0 0 ? ?
? GGO带有实性成分(直径<5mm) 118 118 0 0 ? ?
? 部分实性结节(直径≥5mm) ? ? ? ? ? ?
? ? GGO为主 5 5 0 0 ? ?
? ? 实性为主 8 6 1 1 ? ?
? ? 纯实性 39 23 10 6 ? ?
胸膜凹陷 ? ? ? ? 0.93 0.024
? 无 183 176 5 2 ? ?
? 有 90 79 6 5 ? ?
空气支气管征 ? ? ? ? 2.653 0.546
? 无 157 147 5 5 ? ?
? 有 116 108 6 2 ? ?
CEA水平 ? ? ? ? 14.43 0.000
? ≤5ng/ml 209 204 3 2 ? ?
? >5ng/ml 64 51 8 5 ? ?
病理类型 ? ? ? ? 16.34* 0.000
? AAH 20 20 0 0 ? ?
? AIS 78 78 0 0 ? ?
? MIA 133 133 0 0 ? ?
? IA 42 24 10 8 ? ?
表2 肺腺癌患者CT检查GGO状态与手术方法、淋巴结转移及病理类型的关系
外科病理学特征 纯GGO组 混合性GGO组 纯实性组 χ2/F值 P值
手术方式 ? ? ? 27.553 0.000
? 肺段切除 40 34 2 ? ?
? 肺叶切除 63 97 37 ? ?
淋巴结转移 ? ? ? 21.332* 0.000
? N0 103 129 23 ? ?
? N1 0 1 10 ? ?
? N2 0 1 6 ? ?
病理学类型 ? ? ? 103.211* 0.000
? AAH 20 0 0 ? ?
? AIS 78 0 0 ? ?
? MIA 5 127 1 ? ?
? IA 0 4 38 ? ?
表3 临床分期T1aN0M0肺腺癌淋巴结转移的多因素分析
变量 OR HR(95% CI) P值
GGO状态 44.212 7.901～247.39 0.000
症状 6.501 1.179～35.84 0.032
CEA 7.854 1.486～41.524 0.015
表4 临床T1a期肺腺癌患者纯实体结节淋巴结转移的多因素分析
变量 OR HR(95% CI) P值
肿瘤直径(cm) 2.01 1.000～3.980 0.021
空气支气管征 4.04 2.001～5.990 0.035
症状 70.89 1.887～2.663 0.020
CEA 4.467 1.514～8.498 0.013
[1]
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening[J]. N Engl J Med, 2011, 365(5)：395-409.
[2]
Rami-Porta R, Ball D, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer[J]. J Thorac Oncol, 2007, 2(7)：593-602.
[3]
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group[J]. Ann Thorac Surg, 1995, 60(3): 615-622. discussion 622-623.
[4]
Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis[J]. Cancer, 1995, 75(12)：2844-2852.
[5]
Suzuki K, Yokose T, Yoshida J, et al. Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung[J]. Ann Thorac Surg, 2000, 69(3)：893-897.
[6]
Suzuki K, Asamura H, Kusumoto M, et al. "Early" peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan[J]. Ann Thorac Surg, 2002, 74(5)：1635-1639.
[7]
Suzuki K, Kusumoto M, Watanabe S, et al. Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact[J]. Ann Thorac Surg, 2006, 81(2)：413-419.
[8]
Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201) [J]. J Thorac Oncol, 2011, 6(4)：751-756.
[9]
Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system[J]. Chest, 2009, 136(1)：260-271.
[10]
Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary[J]. Proc Am Thorac Soc, 2011, 8(5)：381-385.
[11]
Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial[J]. Ann Thorac Surg, 2006, 81(3)：1013-1019, discussion 1019-1020.
[12]
Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2cm or less) lung cancer? Retrospective analysis of 225 patients[J]. Eur J Cardiothorac Surg, 2001, 20(5)：1007-1011.
[13]
Fukui T, Katayama T, Ito S, et al. Clinicopathological features of small-sized non-small cell lung cancer with mediastinal lymph node metastasis[J]. Lung Cancer, 2009, 66(3)：309-313.
[14]
Hattori A, Suzuki K, Matsunaga T, et al. Is limited resection appropriate for radiologically "solid" tumors in small lung cancers? [J] Ann Thorac Surg, 2012, 94(1)：212-215.
[15]
Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival? A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification[J]. J Thorac Oncol，2011, 6(9)：1496-1504.
[16]
Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L) [J]. Jpn J Clin Oncol, 2010, 40(3)：271-274.
[17]
Altorki NK, Pass HI, Miller DL, et al. Comparison of different types of surgery in treating patients with stage IA non-small cell lung cancer, ClinicalTrials.gov identifier: NCT00499330[DB/OL]．Bethesda，MD：Clinical Trials Gov，2013.

URL    
[1] 王佳佳, 詹韵韵, 姜凡, 孙碧云, 毕玉, 李如冰, 彭梅. Peyton四步教学法在超声住院医师规范化培训颈部淋巴结分区中的应用[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 814-818.
[2] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[3] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[6] 高一飞, 刘根祥, 孙长华, 周广军. 喉返神经监测在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中的应用效果[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 483-486.
[7] 韩婧, 郝少龙, 康骅. 北京市单中心甲状腺癌患者临床特征的回顾分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 490-493.
[8] 宋佳, 汪波, 孙凯律, 商江峰, 吴旦平, 肇毅. 吲哚菁绿荧光显影联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 498-501.
[9] 蔡永芹, 王君菊, 张敬敬. 不同下纵隔淋巴结清扫顺序在Siewert Ⅱ型食管胃结合部腺癌中应用效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 562-565.
[10] 黄莹, 李璇, 刘梦杨, 彭桂林, 徐鑫, 韦兵, 杨超. 靶向联合治疗双肺移植术后KRAS和BRAF基因双突变晚期肺腺癌一例[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 298-301.
[11] 陆镜明, 韩大为, 任耀星, 黄天笑, 向俊西, 张谞丰, 吕毅, 王傅民. 基于术前影像组学的肝内胆管细胞癌淋巴结转移预测的系统性分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 852-858.
[12] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[13] 杨菲, 刘腾飞, 赵志军, 李睿聪, 张颉, 刘妍, 赵珍. 血清维生素水平与分化型甲状腺癌的关联性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 633-640.
[14] 王曦娅, 尹弘青, 丁伟, 徐滨, 于海源, 马东升, 邵军. 桥本背景下甲状腺乳头状癌多参数分析预测大容量淋巴结转移[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 548-554.
[15] 闫战涛, 王辉, 周梓迪, 史勇强, 陈铜兵. 胃淋巴上皮瘤样癌三级淋巴结构特征及其与预后的相关性[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 455-461.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？