t1非小细胞肺癌纵隔淋巴结跳跃性转移规律及临床意义 - 南京医科大学.doc

T1非小细胞肺癌淋巴结转移规律及临床意义 甄福喜 赵欣* 王俊 赵飞 陈海兵 陈亮 (南京医科大学第一附属医院胸心外科,江苏 南京 210029） [摘要] 目的：探讨T1非小细胞肺癌(NSCLC)淋巴结转移的规律和特点。方法：回顾性分析2011年1月至2012年11月276例行手术治疗T1 NSCLC患者的临床资料，分析淋巴结分布情况及临床病理特征并进行统计学分析。结果：① 276例中66例经病理证实伴淋巴结转移，转移率为23.9%（66/276），高、中低分化NSCLC的胸腔内淋巴结转移率分别为6.1%和33.7%,差异显著（P0.05）。②右肺中叶较右肺上叶、左肺下叶更易发生胸腔内淋巴结转移（X2=5.545,0.01P0.05和X2=5.402, 0.01P0.05）。66例淋巴结转移患者中，各肺叶肿瘤均存在淋巴结跳跃性转移，但无明显统计学差异。结论：在T1 NSCLC中，右肺中叶较易发生胸腔内淋巴结转移,肺癌淋巴结转移频度与肿瘤分化程度相关,且存在跳跃式转移的特点，故针对T1肺NSCLC行肺切除术时施行系统性纵隔淋巴结清扫是非常必要的。 [关键词] T1；非小细胞肺癌；淋巴转移 中图分类号 R655.3 文献标识码 A 文章编号 Clinical analysis of lymph nodes etastasis in T1 non-small cell lung cancer ZHEN Fu-xi,ZHAO Xin*,WANG Jun,ZHAO Fei,CHEN Hai-bing,CHEN Liang (Department of Cardiothoracic Surgery,The First Affiliated Hospital of Nanjin Medical University, Nanjing ,210029, China) [Abstract] Objective:To investigate the characteristics of lymph nodes metastasis in T1 non-small cell lung cancer(NSCLC).Methods:The clinical data of 276 cases underwent resection of NSCLC from January 2011 to November 2012 were analyzed retrospectively,Characteristics of tumors，lymph nodes involvement were analyzed in those cases.Results:① 66 cases confirmed by pathology in 276 cases with lymph node metastasis, metastasis rate was 23.9% (66/276). metastatic rate in group of well differentiated and poorly differentiated were 6.1% and 33.7% respectively,the difference being significant(P0.05). ② The frequency of metastasis was higher in patients with a primary tumor in the right middle lobe compared to the right upper and left lower lobe(x2=5.545,0.01P0.05 and x2=5.402,0.01P0.05).Conclusions:In T1 NSCLC as lymph nodes metastatic rate is closely related with the tumor degree of differentiation.The frequency of metastasis was higher in patients with a primary tumor in the right middle lobe.It is necessary to perform systematic node dissection during pulmonary resection for those patients. [Key words] T1；Non-small cell lung cancer；Lymphatic metastasis T1 NSCLC指肺肿瘤直径≤3cm，被肺或脏层胸膜包