Ⅲa-N2非小细胞肺癌纵隔淋巴结转移综合模式的预后价值

摘要

Objective:To comprehensively investigate the prognostic significance of nodal skip metastasis and lobe-specific me-tastasis for patients with IIIa-N2 non-small-cell lung cancer (NSCLC). Methods:A total of 218 completely resected pN2-NSCLC cases with systematic lymph node dissections from 2008 to 2009 at Tianjin Medical University Cancer Hospital were enrolled. Mediastinal lymph node metastasis was subdivided into continuous metastasis and skip metastasis according to whether N1 lymph nodes were in-volved. Mediastinal lymph node metastasis was also classified into extensive metastasis and lobe-specific metastasis on the basis of whether the lymph nodes involved were within or beyond lobe-specific regions. Overall survival (OS) and disease-free survival (DFS) were compared. Results:For the whole cohort, 5-year OS was 21.6%and 5-year DFS was 16.8%. The 5-year OS for patients with skip metastasis or continuous metastasis were 37.6%and 22.0%, respectively (P=0.008). The 5-year DFS of patients with skip metastasis or continuous metastasis were 29.1%and 15.0%, respectively (P=0.022). The 5-year OS of patients with lobe-specific metastasis and ex-tensive metastasis were 38.3%and 20.4%, respectively (P=0.005). The 5-year DFS of patients with lobe-specific metastasis and exten-sive metastasis were 28.4%and 15.1%, respectively (P=0.009). According to the two patterns, patients were subdivided into three sub-groups:Group A (presence of both skip metastasis and lobe-specific metastasis), Group B (presence of skip metastasis only or lobe-spe-cific metastasis only), and Group C (presence of non-skip metastasis and non-lobe-specific metastasis). The 5-year OS of the three sub-groups were 47.1%(Group A), 28.1%(Group B), and 16.6%(Group C) (P=0.001), and the 5-year DFS of these subgroups were 35.2%(Group A), 20.8%(Group B), and 11.2%(Group C), respectively (P=0.002). Multivariate analysis demonstrated that the combined pat-tern was an independent prognostic factor for both OS and DFS. Conclusion:This combined pattern of lymph node metastasis was a strong prognostic factor for IIIa-N2 NSCLC. This pattern should be considered when predicting prognoses and during the selection of patients that will receive postoperative treatments.%目的：研究跳跃转移与肺叶特异性转移对Ⅲa-N2非小细胞肺癌（non small cell lung cancer，NSCLC）的预后意义。方法：天津医科大学肿瘤医院2008年1月至2009年12月行完全切除和系统淋巴结清扫的218例pN2期NSCLC被纳入本研究。根据有无N1区淋巴结转移将分为连续转移与跳跃性转移；根据纵隔淋巴结转移范围是否超出肺叶特异性区域分为纵隔广泛转移与肺叶特异性转移。对各组的总生存（overall survival，OS）和无病生存（disease free survival，DFS）进行了比较。结果：全组患者的5年OS为21.6%，5年DFS为16.8%。跳跃性转移及连续转移病例的5年OS分别为37.6%和22.0%（P=0.008）；DFS分别为29.1%和15.0%（P=0.022）。肺叶特异性转移和广泛转移的5年OS分别为38.3%和20.4%（P=0.005）；DFS分别为28.4%和15.1%（P=0.009）。根据两者的组合将所有患者进一步分为3组：仅有跳跃性转移和肺叶特异性转移（A组），发生连续转移或者纵隔广泛转移中的一项（B组）；既有连续转移又有纵隔广泛转移（C组）。3组的5年OS分别为47.1%，28.1%和16.6%（P=0.001）；5年DFS分别为35.2%，20.8%和11.2%（P=0.002）。多因素分析表明，这种综合转移模式是OS和DFS的独立预后因素。结论：淋巴结转移的综合模式是Ⅲa-N2的一种独立的预后因素，在评价患者预后及筛选术后治疗患者时应该将这种综合模式考虑在内。