The Significance of Systematic Mediastinal Lymphadenectomy and Mediastinal Lymph node Sampling in Operations of Stage-N0 NSCLC
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摘要: 目的 :研究临床分期为N0的NSCLC术后淋巴结转移情况与术后生存率之间的差异,探讨临床分期为N0的NSCLC纵隔淋巴结清扫或采样的必要性。 方法 :回顾1985年1月～2000年6月手术切除的术前判断为N0的手术病例,对比术后淋巴结转移情况,判断术前cTNM与pTNM的偏差,以及患者生存率的变化。 结果 :本组cTNM分期总的准确率为42.32%(201/475),临床Ⅰ期的NSCLC(cT1N0M0、cT2N0M0)中出现N1或N2淋巴结转移的病例(pT1N1M0、pT1N2M0、pT2N1M0、pT2N2M0)与未出现转移的病例(pT1N0M0、pT2N0M0)之间的生存率之间差异显著,P<0.01。本组cT3N0M0与pT3N1M0、pT3N2M0之间生存率差异不明显。 结论 :尽管临床Ⅰ期的NSCLC(cT1N0M0、cT2N0M0)临床上无淋巴结转移证据,但由于临床分期与术后病理分期客观上存在差异,淋巴结清扫及采样仍是必要的,任何不能行淋巴结清扫的肿瘤局部治疗方法都可能是不充分的。Abstract: Objective :To evaluate pre-and postoperative mediastinal metastasis and survival rateand to discuss the necessity of systematic mediastinal lymphadenectomy and mediastinal lymph nodesampling during surgery of stage-N0 non-small cell lung cancer (NSCLC). Methods :Comparative studyof postoperative mediastinal metastasis and survival rate of N0 NSCLC between those without metastasis(N0) and with metastasis (N1 or N0) was conducted to evaluate the necessity of systematic mediastinallymphadenectomy and mediastinal lymph node sampling during surgery of N0 NSCLC. Results :The to-tal accuracy of cTNM staging was 42.32 (201/475), and the difference was more significant in thosewithout metastasid:\PDF\.pdfs (pT1N0M0,pT2N0M0) than those with metastasis (pT1N1M0,pT1N2M0,pT2N1M0,pT2N2M0) in the stage-ⅠNSCLC (cT1N0M0,cT2N0M0) (P<0.01), but the difference was not significantbetween cT3N0M0 and pT3N1M0, pT3N2M0. Conclusions :Though no evidence of mediastinal lymphnode metastasis has been found in the stage-Ⅰ NSCLC (cT1N0M0,cT2N0M0), the systematic mediastinallymphadenectomy and mediastinal lymph node sampling in clinical N0 NSCLC operations are still nec-essary owing to the difference between the clinical stage and postoperative pathologic stage. Any localtherapy without systematic mediastinal lymphadenectomy and mediastinal lymph node sampling is in-complete and unsatisfactory in the treatment of stage-N0 NSCLC.
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