临床早期非小细胞肺癌淋巴结转移相关因素分析

发布时间：2018-05-31 17:34

本文选题：非小细胞肺癌 + 危险因素　；参考：《浙江大学》2015年博士论文

【摘要】：目的：准确的分期对于非小细胞肺癌的治疗极其重要,本研究旨在研究分析临床IA期非小细胞肺癌患者术后病理证实出现纵隔淋巴结转移的发生率,确定易发生纵隔淋巴结转移的临床IA期非小细胞肺癌的危险人群,指导临床选择合适手术适应症的患者。同时确定淋巴结转移站点与肿瘤所在位置的关系,为优化淋巴结清扫提供理论数据支持。方法：本研究回顾性分析2011年1月—2013年1月期间于我科行外科治疗的临床IA期患者资料,统计术后病理确诊为纵隔淋巴结转移比例,通过单因素和多因素分析确定纵隔淋巴结转移危险因素,同时使用受试者工作特征曲线(ROC)及约登指数指数确定危险因素的最佳分界值。同时分析淋巴结转移性肺癌的转移站点与肿瘤所在肺叶的相关性。结果：本研究纳入552例临床IA期患者,105例(19.0%)患者术后病理证实为纵隔淋巴结转移。多因素分析提示3个独立危险因素,分别为性别(OR=2.722,p=0.001),术前血清CEA水平(OR=1.049,p=0.006),肿瘤大小(OR：1.875,p=0.002)。ROC曲线及约登指数提示肿瘤大小及血清CEA值的最佳分界值分别为1.8cm,5.2ng/ml。分析105例纵隔淋巴结转移性肿瘤显示,右上叶肿瘤转移至第4组淋巴结的比例显著高于右下叶肿瘤(p0.001),两者分别为76.7%,32.0%,而右上叶肿瘤转移至第7组淋巴结的比例显著低于右下叶肿瘤(p=0.002),两者比例分别为23.3%,64.0%。左上叶肿瘤发生5,6组淋巴结转移的比例明显高于左下叶肿瘤(p=0.003),分别为90.9%,62.5%,而左下叶转移至第7组淋巴结比例明显高于左上叶,分别为0%,56.3%,两者差异有显著性(p0.001)。结论：临床IA期肺癌患者发生纵隔淋巴结转移的比例较高,因此对于此类患者仍因行系统性地淋巴结清扫或采样以获得术后准确的病理分期。对有相关危险因素的患者,术前需进行更准确的临床分期以避免不恰当的治疗方式。肺癌淋巴结转移站点存在肺叶特异性。目的：准确的临床分期对于非小细胞肺癌患者的正确诊治极其重要,尤其是对于临床T1aNOMO患者,因其可以作为肺段切除的参考适应症,本研究旨在探讨临床T1aNOMO患者术后病理证实出现淋巴结转移比例及其相关危险因素,指导选择肺段切除的最佳适应症患者。方法：本研究回顾性分析2011年1月—2013年6月期间于我科行外科治疗的临床T1aNOMO患者资料,统计术后病理确诊为淋巴结转移的比例,通过单因素和多因素分析确定该临床分期患者发生淋巴结转移危险因素。结果：该研究共纳入315例患者,发生淋巴结转移51例(16.2%),其中N1淋巴结发生转移的共39例(12.4%),N2发生转移的共41例(13.0%),29例患者(9.2%)N1、N2淋巴结同时存在转移,12例(3.8%)患者存在跳跃性N2转移。术前影像学结节大小,非上叶肿瘤,血清癌胚抗原(CEA)升高,微乳头状腺癌为淋巴结转移的独立危险因素。结论：临床T1aNOMO患者发生淋巴结转移的比例较高,选择行肺段切除之前需准确评估该分期的患者,尤其是对于有上述危险因素的患者。
[Abstract]:Objective: accurate staging is very important for the treatment of non small cell lung cancer. The purpose of this study is to analyze the incidence of mediastinal lymph node metastases in patients with stage IA non-small cell lung cancer (non-small cell lung cancer) and to determine the risk population of IA non small cell lung cancer (non small cell lung cancer) with mediastinal lymph node metastasis, and to guide the clinical selection. At the same time, the location of lymph node metastasis and the location of tumor were also determined to provide theoretical data support for optimizing lymph node dissection.
Methods: a retrospective analysis of the clinical data of IA patients in our department from January 2011 to January 2013 was reviewed. The proportion of mediastinal lymph node metastases was confirmed by pathology after surgery. The risk factors of mediastinal lymph node metastases were determined by single factor and multifactor analysis, and the subjects' work feature curve (ROC) and Joseph's finger were also used. The number index was used to determine the best cut-off value of risk factors. Meanwhile, the correlation between metastatic sites of lymph node metastatic lung cancer and lung lobe of tumor was analyzed.
Results: This study included 552 patients with clinical IA stage, 105 (19%) patients proved to be mediastinal lymph node metastasis after operation. Multivariate analysis suggested that 3 independent risk factors were sex (OR=2.722, p=0.001), preoperative serum CEA level (OR=1.049, p=0.006), OR:1.875, p=0.002.ROC curve and Joseph's index. The best demarcation value of the size and CEA value of the serum was 1.8cm. 5.2ng/ml. analysis of 105 cases of metastatic tumor of the mediastinal lymph nodes showed that the proportion of the right upper lobe tumor to fourth groups was significantly higher than that of the right lower lobe tumor (p0.001), which were 76.7% and 32% respectively, while the proportion of the right upper lobe metastases to the seventh lymph nodes was significantly lower than that of the lower right lobes. The proportion of tumor (p=0.002) was 23.3%. The proportion of lymph node metastasis in 5,6 group of 64.0%. left upper lobe tumor was significantly higher than that of left lower lobe tumor (p=0.003), which was 90.9% and 62.5% respectively. The ratio of left lower lobe to seventh groups was significantly higher than that in upper left lobe, 0% and 56.3%, respectively (p0.001).
Conclusion: the incidence of mediastinal lymph node metastasis in patients with stage IA lung cancer is higher, so the patient still has a systematic lymphnode dissection or sampling to obtain accurate postoperative pathological staging. For patients with related risk factors, a more accurate clinical period is required before surgery to avoid inappropriate treatment. Pulmonary lobe specificity exists in the nodal metastasis site.
Objective: accurate clinical staging is very important for the correct diagnosis and treatment of patients with non-small cell lung cancer, especially for clinical T1aNOMO patients, because it can be used as a reference indication for pulmonary segmental resection. The purpose of this study is to explore the incidence of lymph node transfer and related risk factors in clinical T1aNOMO patients, and to guide the selection of lung. The best adaptable patient with segmental resection.
Methods: a retrospective analysis of the clinical data of T1aNOMO patients in our department from January 2011 to June 2013 was reviewed. The proportion of lymph node metastases was confirmed by pathology after surgery, and the risk factors of lymph node metastasis were determined by single factor and multi factor analysis.
Results: the study included 315 patients with 51 cases of lymph node metastasis (16.2%), of which 39 cases of N1 lymph node metastasis (12.4%), 41 cases (13%), 29 patients (9.2%) N1, N2 lymph node metastasis and 12 (3.8%) patients with jump N2 metastasis. Embryonal antigen (CEA) is elevated and micro papillary adenocarcinoma is an independent risk factor for lymph node metastasis.
Conclusion: the proportion of lymph node metastases in the clinical T1aNOMO patients is higher. The patients who are selected for the stage of the pulmonary resection should be accurately evaluated, especially for the patients with the risk factors mentioned above.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R734.2

【共引文献】