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目的采用PET/CT分析非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移特点,为放疗患者勾画靶区提供参考依据。方法 375例初治NSCLC患者在治疗前行18F-FDG PET/CT扫描,对不同原发灶部位、分期及病理类型发生纵隔淋巴结转移情况进行统计分析。结果PET/CT结果显示,207例右肺NSCLC纵隔淋巴结转移率由高到低依次为同侧肺门、4R、7、5、2R、10~11L、6区;168例左肺NSCLC纵隔淋巴结转移率依次为同侧肺门淋巴结、5、7、6、4L、4R、10~11R区。中肺和下肺NSCLC的7区转移率显著高于上肺。鳞癌和腺癌纵隔淋巴结转移差异无统计学意义(P>0.05)。随着患者T分期增加,更容易发生纵隔淋巴结转移。375例NSCLC患者中有88例发生了跳跃式转移,占23.5%。191个跳跃转移区中,4R、7、5、6、2R占有较高比例。纵隔淋巴结跳跃式转移与NSCLC原发灶部位、病理类型及分期无相关性(P>0.05)。结论 PET/CT提示左右肺NSCLC患者纵隔淋巴结转移高危区不同,建议右肺NSCLC放疗靶区应包括10~11R、4R、7、5区;左肺NSCLC放疗靶区应包括10~11L、5、7、6、4L、4R区。
Objective To analyze the characteristics of mediastinal lymph node metastasis in non-small cell lung cancer (NSCLC) by PET / CT and to provide a reference for delineating target areas in radiotherapy patients. Methods 375 cases of newly diagnosed NSCLC patients underwent 18F-FDG PET / CT scan before treatment, and statistical analysis was made on the location, stage and pathological type of mediastinal lymph node metastasis in different primary sites. Results The PET / CT results showed that the metastatic rates of mediastinal lymph nodes in 207 right lung NSCLC were hilar, 4R, 7, 5, 2R, 10 ~ 11L and 6 zones from high to low. 168 cases of left lung NSCLC mediastinal lymph node metastasis Rates followed by ipsilateral hilar lymph nodes, 5,7,6,4 L, 4R, 10 ~ 11R area. The rates of metastasis in zone 7 of middle and lower lung NSCLC were significantly higher than those of the upper lung. There was no significant difference in mediastinal lymph node metastasis between squamous cell carcinoma and adenocarcinoma (P> 0.05). As the patient’s T stage increased, more prone to mediastinal lymph node metastasis. Of the 375 patients with NSCLC, 88 had a leapfrog transfer, accounting for 23.5%. Of the 191 jump transfer regions, 4R, 7,5,6,2R occupy a higher proportion. There was no correlation between the leaping metastasis of mediastinal lymph nodes and the location, pathological type and stage of primary NSCLC (P> 0.05). Conclusion PET / CT suggests that the mediastinal lymph node metastases in patients with left and right lung NSCLC are different from each other in high risk areas. It is suggested that radiotherapy target area of right lung NSCLC should include 10 ~ 11R, 4R, 7 and 5 areas. The left lung NSCLC radiotherapy target area should include 10 ~ 11L, 7,6,4L, 4R area.