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Abstract：
OBJECTIVE: To explore the independent predictors of pathological mediastinal lymph node (pN2) metastasis in clinical stage IA (cIA) pure-solid non-small cell lung cancer (NSCLC) patients, and to find an appropriate method of mediastinal lymph node dissection.
METHODS: This study retrospectively evaluated 533 cIA pure-solid NSCLC patients who underwent radical resection of lung cancer (lobectomy combined with systematic lymph node dissection) from January 2014 to December 2016. The relationship between clinicopathological characteristics and pN2 metastasis was analyzed, and the independent predictors of pN2 metastasis were determined by univariate and multivariate logistic regression analysis. We defined the new factor Y as composed of preoperative cT, CEA, and NSE.
RESULTS: There were 72 cases (13.5%) of pN2 metastasis in cIA pure-solid NSCLC patients. Preoperative clinical tumor diameter (cT), serum CEA level, serum NSE level, and pathological status of station 10 lymph nodes were independent predictors of pN2 metastasis. Patients with cT ≤ 21.5 mm, CEA ≤ 3.85 ng/mL, NSE ≤ 13.40 ng/mL and negative station 10 lymph node group showed lower rates of pN2 metastasis. The new factor Y was an independent predictor of pN2 metastasis. Only 3 (2.1%) of 143 patients in the Y low-risk group showed pN2 metastasis.
CONCLUSIONS: For patients with low risk of pN2 metastasis, it might be feasible to take lobe-specific lymph node sampling or systematic lymph node sampling. As for those with high risk of pN2 metastasis, systematic lymph node dissection would be recommended.
METHODS: This study retrospectively evaluated 533 cIA pure-solid NSCLC patients who underwent radical resection of lung cancer (lobectomy combined with systematic lymph node dissection) from January 2014 to December 2016. The relationship between clinicopathological characteristics and pN2 metastasis was analyzed, and the independent predictors of pN2 metastasis were determined by univariate and multivariate logistic regression analysis. We defined the new factor Y as composed of preoperative cT, CEA, and NSE.
RESULTS: There were 72 cases (13.5%) of pN2 metastasis in cIA pure-solid NSCLC patients. Preoperative clinical tumor diameter (cT), serum CEA level, serum NSE level, and pathological status of station 10 lymph nodes were independent predictors of pN2 metastasis. Patients with cT ≤ 21.5 mm, CEA ≤ 3.85 ng/mL, NSE ≤ 13.40 ng/mL and negative station 10 lymph node group showed lower rates of pN2 metastasis. The new factor Y was an independent predictor of pN2 metastasis. Only 3 (2.1%) of 143 patients in the Y low-risk group showed pN2 metastasis.
CONCLUSIONS: For patients with low risk of pN2 metastasis, it might be feasible to take lobe-specific lymph node sampling or systematic lymph node sampling. As for those with high risk of pN2 metastasis, systematic lymph node dissection would be recommended.
摘要：
目的：探讨临床IA(cIA)期纯实性非小细胞肺癌(NSCLC)患者纵隔淋巴结(pN2)转移的独立预测因素。寻找合适的纵隔淋巴结清扫方法。
方法：本研究回顾性评估了2014年1月至2016年12月533例cIA纯实性NSCLC患者行肺癌根治术（肺叶切除联合系统淋巴结清扫）。分析临床病理特征与pN2转移的关系,通过单因素和多因素logistic回归分析确定pN2转移的独立预测因子。我们将新因子Y定义为术前cT，CEA,和NSE。
结果：cIA纯实体NSCLC患者pN2转移72例（13.5％）。术前临床肿瘤直径(cT),血清CEA水平,血清NSE水平,10站淋巴结的病理状态是pN2转移的独立预测因素。cT≤21.5mm的患者，CEA≤3.85ng/mL，NSE≤13.40ng/mL，阴性10站淋巴结组pN2转移率较低。新因子Y是pN2转移的独立预测因子。Y低危组中143例患者中只有3例（2.1％）出现pN2转移。
结论：对于pN2转移风险低的患者，采取肺叶特异性淋巴结取样或系统淋巴结取样可能是可行的。对于那些有pN2转移风险的人，系统的淋巴结清扫将被推荐。
方法：本研究回顾性评估了2014年1月至2016年12月533例cIA纯实性NSCLC患者行肺癌根治术（肺叶切除联合系统淋巴结清扫）。分析临床病理特征与pN2转移的关系,通过单因素和多因素logistic回归分析确定pN2转移的独立预测因子。我们将新因子Y定义为术前cT，CEA,和NSE。
结果：cIA纯实体NSCLC患者pN2转移72例（13.5％）。术前临床肿瘤直径(cT),血清CEA水平,血清NSE水平,10站淋巴结的病理状态是pN2转移的独立预测因素。cT≤21.5mm的患者，CEA≤3.85ng/mL，NSE≤13.40ng/mL，阴性10站淋巴结组pN2转移率较低。新因子Y是pN2转移的独立预测因子。Y低危组中143例患者中只有3例（2.1％）出现pN2转移。
结论：对于pN2转移风险低的患者，采取肺叶特异性淋巴结取样或系统淋巴结取样可能是可行的。对于那些有pN2转移风险的人，系统的淋巴结清扫将被推荐。
