ANN SURG ONCOL：部分非小细胞肺癌无需行系统性淋巴结清扫术

患者淋巴结状况分布

　　过去20年间，在探究小病灶肺癌中N0期状态的可靠预测因素方面进行了大量研究。然而，一直未能得到测定肿瘤体积方法的清晰阐述，并且对于亚厘米肿瘤患者是否应系统性淋巴结清扫也仍然存在着争议。为此，我国上海复旦大学附属肿瘤医院胸外科陈海泉教授与张扬博士等人进行了一项相关研究，该研究结果发表于2012年12月24日的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

　　共有243例周围型非小细胞小肺癌患者被纳入了该项研究，研究人员在对新鲜样本进行甲醛溶液固定之前进行了肿瘤体积测量，并将这些患者的淋巴结侵犯情况与临床病理学变量间的联系进行考察。并根据国际肺癌研究协会(IASLC)/美国胸科学会(ATS)/欧洲呼吸协会(ERS)最新发布的肺腺癌分类标准，对患者样本的腺癌组织学亚型进行分类。

　　研究人员发现，N1 与N2期淋巴结侵犯率分别为5.3%以及6.6 %。部分亚厘米肿瘤为N2 期(2/53, 3.8 %)。研究还发现，鳞状细胞癌、原位腺癌、微浸润腺癌、贴壁状为主的腺癌或浸润性粘液腺癌均无淋巴结转移。总体而言，该5类细胞占全部周围型小病灶非小细胞肺癌病例的34.6 %。

　　陈教授等人认为，尽管通过对肿瘤体积的精确测量发现，肿瘤体积并非N0期状态的可靠预测因素。然而，超过三分之一的周围型小病灶NSCLC仍可通过组织学分类，避免进行系统性淋巴结清扫术。　

Predictive Factors of Lymph Node Status in Small Peripheral 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 peripheral 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 peripheral 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 peripheral NSCLC.