Significance of Skip Mediastinal Lymph Node Metastasis in Non-Small Cell Lung Cancer

縱膈腔淋巴腺跳躍轉移在非小細胞肺癌的重要性

許南榮(Nan-Yung Hsu) ； 陳志毅(Chih-Yi Chen) ； 徐中平(Chung-Ping Hsu) ； 王丕延(Pei-Yen Wang)

《Mid-Taiwan Journal of Medicine》 3卷1期 (1998/03) Pp. 14-20

https://doi.org/10.6558/MTJM.1998.3(1).3

摘要

我們回溯性地分析173例，經手術切除非小細胞肺癌合併同側縱騙腔淋巴腺轉N移2病例，探討跳躍轉移的臨床意義。在這173例N2病例中，病人分為二組，N1(-)指無肺門或肺葉淋巴腺轉移，即認定為有跳躍轉移，佔49例（28%）；N1(+)則有肺門或肺葉淋巴腺轉移，佔124例（72%）。比較這二組，發現無論在性別、年齡、腫瘤大小、細胞組織類型、細胞分化度、腫瘤位置，或轉移群的數日，都無統計學上顯著差異。五年存活率，在所有N2病例，N1(-)，N1(+)三組中，也無顯著差異。將N2病例，分為上縱膈群、主動脈群，和下縱膈群，發現這三群病例中，其N1(-)和N1(+)的五年存活率分別為5%對15%，0%對14%和0%對14%。二者並無統計學上差異。在平均36個月的追蹤期中，N1(-)和N1(+)二組病例，在局部復發和遠處轉移，分別為43%和45%，並無統計學上顯著差異。值得注意，在跳躍轉移病人中，只有轉移至1處的五年存活率為11%（平均站1個月），如轉移言已處，則五年存活率為0%（平均10.4個月），二者有顯著性差異（p值0.0133）。我們的結果顯示在N2病例的淋巴腺跳躍轉移，雖然臨床上的意義有限，但產生的頻率值得注意。是故，在肺癌手術當中，必須對肺門和縱隔腔淋巴腺做完整的清除。

關鍵字

縱隔腔淋巴腺轉移 ； 非小細胞肺癌 ； 跳躍轉移

並列摘要

We retrospectively analysed 173 cases of resected non-small cell lung cancer (NSCLC) in patients with ipsilateral mediastinal (N2) lymph node metastasis in order to clarify the clinical significance of skip metastasis (SM). The patients were classified into N1(-): no hilar or lobar node metastasis recognized as SM (49 patients, 28%); and N1(+): hilar or lobar node metastasis (124 patients, 72%). There was no statistical difference between the two groups with regard to sex, age, T status, cell type, cell differentiation, side of primary tumor, and number of N2 metastatic sites. The 5-year survival rates for all patients with N2 diseases, and the N1(-) and N1(+) subgroups were 13%, 7% and 15% , respectively. No statistical difference was observed between the three groups. When the sites of N2 metastasis were classified as ＂superior＂, ＂aortic＂ and ＂inferior＂, the 5- year survival rates of the patients in the N1(-) and N1(+) groups with superior metastasis, aortic metastasis, and inferior metastasis were 5% vs 15%, 0% vs 14%, and 0% vs 14%, respectively. No statistical difference were found between the survival rates of these groups. During the median follow-up time of 36 months, the recurrence rates, local or distant, of both N1(-) and N(+) patients were 43% and 45%, respectively. No statistically significant difference was found between these recurrence rates. The 5-year survival rates of SM was significantly correlated with the number of metastatic sites, 11% in one site (median survival time, 25.1 months) vs 0% in three sites (median survival time, 10.4 months) (p=0.013). These results suggest that although the clinical significance of this finding for SM in N2 disease of non-small cell lung cancer is limited to the patients with hilar or lobar node involvement, complete dissection of hilar and mediastinal lymph nodes should be performed in all patients with N2 disease because of the notable frequency of SM in this region.

並列關鍵字

mediastinal lymph node metastasis ； non-small cell lung cancer ； skip metastasis