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目的:目前对于早期非小细胞肺癌(non-small-cell lung cancer,NSCLC)纵隔淋巴结转移模式的研究尚少。本研究旨在了解这些患者的不同临床特征是否会引起肺叶特异性淋巴结转移率和非特异性纵隔淋巴结转移率的不同变化,从而推测在早期NSCLC患者中行单纯肺叶特异性淋巴结清扫的临床适应证。方法:调查了609例肺叶切除术和系统纵隔淋巴结清扫的c TNM-Ⅰ期的NSCLC患者。从临床资料包括肿瘤大小、肿瘤的组织学类型、性别和年龄等方面来分析肺叶特异性纵隔淋巴结转移率和非特异性纵隔淋巴结的转移率。结果:符合以下特点的Ⅰ期NSCLC患者的纵隔淋巴结转移大部分被限制在了肺叶特异性纵隔淋巴结:(1)男性,年龄>60岁,鳞状细胞癌,肿瘤最大径≤5 cm;(2)男性,年龄≤60岁,鳞状细胞癌,肿瘤最大径≤3 cm;(3)女性,鳞状细胞癌,肿瘤最大径≤3 cm;(4)腺癌,肿瘤最大径≤2 cm。结论:符合以上条件的术前c TNM-Ⅰ的NSCLC患者的纵隔淋巴结转移大部分局限于肺叶特异性淋巴结,对于这些患者,单纯清扫其肺叶特异性淋巴结是足够的;而其他患者出现肺叶非特异性纵隔淋巴结转移的风险将会明显升高,对于这类患者,系统的淋巴结清扫仍是最为有效的方法。
OBJECTIVE: There is little research on the mode of mediastinal lymph node metastasis in early non-small-cell lung cancer (NSCLC). The purpose of this study was to determine whether different clinical characteristics of these patients led to different changes in lobular-specific lymph node metastases and nonspecific mediastinal lymph node metastases to predict the clinical indications for simple lobar-specific lymph node dissections in patients with early-stage NSCLC. METHODS: Sixty-nine patients with c TNM-I stage NSCLC underwent lobectomy and systematic mediastinal lymph node dissection were investigated. Lung-specific mediastinal lymph node metastases and non-specific mediastinal lymph node metastases were analyzed from clinical data including tumor size, histological type of tumor, sex and age. RESULTS: Most of mediastinal lymph node metastases in patients with stage I NSCLC were limited to lung-specific mediastinal lymph nodes: (1) males> 60 years old with squamous cell carcinoma, with a maximum tumor diameter of <5 cm; (2) ) Male, ≤ 60 years of age, squamous cell carcinoma, the largest diameter of tumor ≤ 3 cm; (3) female, squamous cell carcinoma, the largest diameter of tumor ≤ 3 cm; (4) adenocarcinoma, the largest diameter of tumor ≤ 2 cm. CONCLUSION: Most of the mediastinal lymph node metastases of NSCLC patients with preoperative c TNM-I that meet the above criteria are mostly localized to lobar lymph node-specific lymph nodes. For these patients, simple dissection of their lobe-specific lymph nodes is adequate. Non-specific lung lobes are found in other patients The risk of mediastinal lymph node metastasis will be significantly increased, for these patients, the system of lymph node dissection is still the most effective way.