【摘要】 目的:探讨与周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)淋巴结隐匿转移有关的临床病理因素。方法:复习191例接受肺癌根治性手术的临床N0M0周围型NSCLC,分析肿瘤的大小、部位、病理类型、脏层胸膜有无受侵、血清CEA、CA199、CA125及肿瘤组织p53蛋白等8个临床病理参数与淋巴结转移的关系。结果:全组淋巴结转移率〔pN1和(或)pN2转移〕为44.5%(85/191);纵隔淋巴结转移率(pN2转移)为25.1%(48/191)。单因素分析显示,脏层胸膜受侵(P=0.001)、血清CEA升高(P=0.001)、肿瘤部位(P=0.043)与pN1和(或)pN2转移显著相关。脏层胸膜受侵(P=0.000)、血清CEA升高(P=0.000)、腺癌(P=0.022)与pN2转移显著相关。Logistic多元回归分析显示,脏层胸膜受累、血清CEA值升高是影响pN1和(或)pN2转移的独立预后因素,脏层胸膜受累、血清CEA值升高、pN1转移是影响pN2转移的独立预后因素。结论:周围型NSCLC具有较高的隐匿性淋巴结转移率。血清CEA升高、胸膜侵犯是淋巴结转移的高危险因素,建议须进一步检查(纵隔镜、PET-CT);腺癌较易出现纵隔淋巴结转移,而鳞癌少见。肺门淋巴结有转移时易出现纵隔淋巴结转移。更多还原

【Abstract】 OBJECTIVE:To study the risk factors associated with nodal occult metastasis in peripheral non-small cell lung cancer. METHODS:A total of 191 cases of cN0M0 peripheral NSCLC who received radical surgery were reviewed to evaluate the correlation of eight clinicopathologic factors (tumor size,tumor location,serum CEA level,serum CA-199 level,serum CA-125 level,expression of p53 protein,pleural invasion,histopathological types) with nodal occult metastasis. RESULTS:The metastatic rate of pN1 and/or pN2 was 44.5%(85/191); the metastatic rate of pN2 was 25.1%(48/191). It was found that pleural invasion (P=0.001),increase of serum CEA level (P=0.001),and lower lobe tumors (P=0.043) were correlated with pN1 and/or pN2 involvement and pleural invasion (P=0.000); increase of serum CEA level (P=0.000) and adenocarcinoma (P=0.022) were correlated with pN2 involvement. Logistic regression analysis showed that pleural invasion and increase of serum CEA level were independent factors for pN1 and/or pN2 involvement and that pleural invasion,increase of serum CEA level and pN1(+)were independent factors for pN2 involvement. CONCLUSIONS:Peripheral NSCLC has a high occult nodal involvement. pN2 involvement is more often seen in adenocarcinoma than in squamous cell carcinoma. Because of high risk of nodal occult metastasis in those with pleural invasion,the increase of serum CEA level,suggests that further examinations (mediastinoscopy,PET-CT)should be undertaken. pN1 involvement is associated with a higher pN2 involvement.更多还原