患者淋巴結(jié)狀況分布

　　過去20年間，在探究小病灶肺癌中N0期狀態(tài)的可靠預(yù)測(cè)因素方面進(jìn)行了大量研究。然而，一直未能得到測(cè)定腫瘤體積方法的清晰闡述，并且對(duì)于亞厘米腫瘤患者是否應(yīng)系統(tǒng)性淋巴結(jié)清掃也仍然存在著爭(zhēng)議。為此，我國(guó)上海復(fù)旦大學(xué)附屬腫瘤醫(yī)院胸外科陳海泉教授與張揚(yáng)博士等人進(jìn)行了一項(xiàng)相關(guān)研究，該研究結(jié)果發(fā)表于2012年12月24日的《外科腫瘤學(xué)年鑒》(Annals of Surgical Oncology)雜志上。

　　共有243例周圍型非小細(xì)胞小肺癌患者被納入了該項(xiàng)研究，研究人員在對(duì)新鮮樣本進(jìn)行甲醛溶液固定之前進(jìn)行了腫瘤體積測(cè)量，并將這些患者的淋巴結(jié)侵犯情況與臨床病理學(xué)變量間的聯(lián)系進(jìn)行考察。并根據(jù)國(guó)際肺癌研究協(xié)會(huì)(IASLC)/美國(guó)胸科學(xué)會(huì)(ATS)/歐洲呼吸協(xié)會(huì)(ERS)最新發(fā)布的肺腺癌分類標(biāo)準(zhǔn)，對(duì)患者樣本的腺癌組織學(xué)亞型進(jìn)行分類。

　　研究人員發(fā)現(xiàn)，N1 與N2期淋巴結(jié)侵犯率分別為5.3%以及6.6 %。部分亞厘米腫瘤為N2 期(2/53, 3.8 %)。研究還發(fā)現(xiàn)，鱗狀細(xì)胞癌、原位腺癌、微浸潤(rùn)腺癌、貼壁狀為主的腺癌或浸潤(rùn)性粘液腺癌均無淋巴結(jié)轉(zhuǎn)移?？傮w而言，該5類細(xì)胞占全部周圍型小病灶非小細(xì)胞肺癌病例的34.6 %。

　　陳教授等人認(rèn)為，盡管通過對(duì)腫瘤體積的精確測(cè)量發(fā)現(xiàn)，腫瘤體積并非N0期狀態(tài)的可靠預(yù)測(cè)因素。然而，超過三分之一的周圍型小病灶NSCLC仍可通過組織學(xué)分類，避免進(jìn)行系統(tǒng)性淋巴結(jié)清掃術(shù)。

　　Predictive Factors of Lymph Node Status in Small Pe**heral Non-small Cell Lung Cancers: Tumor Histology is More Reliable

　　Background

　　During the past two decades, many studies have sought to find reliable predictors of N0 status in small-sized lung cancers. However, the way of tumor size measurement was usually not clearly stated, and controversy remains as to whether systematic lymph node dissection should be performed in patients with subcentimeter tumors.

　　Methods

　　We reviewed correlations between lymph node involvement and clinicopathological variables in 243 small pe**heral non-small cell lung cancers with their size measured in fresh specimens before formalin fixation. Histologic subtypes of adenocarcinomas were classified in line with the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) lung adenocarcinoma classification.

　　Results

　　Incidence of N1 and N2 nodal involvement was 5.3 and 6.6 %, respectively. N2 disease was present in a proportion of subcentimeter tumors (2/53, 3.8 %). No lymph node metastasis was revealed in squamous cell carcinomas, adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma, or invasive mucinous adenocarcinoma. Collectively, the five cell types accounted for 34.6 % of all the small pe**heral cases.

　　Conclusions

　　Precise measurement of tumor size in fresh tissues revealed that tumor size was not a reliable predictor of N0 status. However, through histologic classification, systematic lymph node dissection might be avoided in more than one third of small pe**heral NSCLC.