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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:
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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
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