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孤立肺结节型非小细胞肺癌的叶特异性淋巴结清扫方案
A lobe-specific lymphadenectomy protocol for solitary pulmonary nodules in non-small cell lung cancer
Xue-Ning Yang, Ze-Rui Zhao,Wen-Zhao Zhong, Qiang Nie, Ri-Qiang Liao, Song Dong. A lobe-specific lymphadenectomy protocol for solitary pulmonary nodules in non-small cell lung cancer. Chin J Cancer Res. 2015 Dec;27(6):538-44. doi: 10.3978/j.issn.1000-9604.2014.11.04. PMID: 26752927; PMCID: PMC4697101.
Background: We want to establish a lobe-specific mediastinal lymphadenectomy protocol for solitary pulmonary nodules (SPNs) in non-small cell lung cancer (NSCLC). Methods: We retrospectively analyzed 401 patients with pathological diagnoses of NSCLC who underwent lobectomy, bilobectomy, or pneumonectomy with systematic lymphadenectomy from March 2004 to June 2011 in our hospital. All of the patients enrolled had a SPN preoperatively. Information about the primary tumor location, lymph node metastasis, and other baseline data were collected. Stepwise logistic regression was used to identify the key factors indicating non-regional mediastinal lymph node metastases (NRM). Results: Of the primary tumors, 117, 39, 74, 104, and 67 were in the right upper lung (RUL), right middle lung (RML), right lower lung (RLL), left upper lung (LUL), and left lower lung (LLL), respectively. Stepwise regression showed that #2,4, #10,11, and #10,11 as well as #7 was the key lymph node station for RUL, LUL, and lower lobes: #2,4 [odds ratio (OR)=28.000, 95% confidence interval (CI): 2.917-268.790, P=0.004] for RUL, #10,11 (OR=31.667, 95% CI: 2.502-400.833, P=0.008) for LUL, #10,11 (OR=19.540, 95% CI: 4.217-90.541, P<0.001) and #7 (OR=7.395, 95% CI: 1.586-34.484, P=0.011) for lower lobes, respectively. Patients with tumors >2 cm rarely had NRM without primary regional mediastinal involvement. Conclusions: With rigid consideration, a lobe-specific lymphadenectomy is feasible in practice. This protocol can be used when the lobe-specific key nodes are negative in intraoperative frozen sections, especially for NSCLC diagnosed as SPN <2 cm preoperatively.
表1. 孤立肺结节型非小细胞肺癌的叶特异性淋巴结清扫方案
◎, 要求区域淋巴结清扫;
○, 不需区域淋巴结清扫;
a, 当#2,4站淋巴结术中冰冻阴性时不需清扫;
b, 当#10,11站淋巴结术中冰冻阴性时不需清扫;
c, 当#10,11 and #7 站淋巴结术中冰冻阴性时不需清扫;
^Superiror mediastinum(上纵隔) , RUL（右上肺）包括#1-4站淋巴结，LUL（左上肺）包括 #4-7站淋巴结.
SPNs, solitary pulmonary nodules;
NSCLC, non-small cell lung cancer;
RUL, right upper lung; LUL, left upper lung; RLL, right lower lung; LLL, left lower lung; RML, right middle lung. |
