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目的分析非小细胞肺癌隆突下淋巴结转移的方式和规律,以探讨其隆突下淋巴结合理的手术清扫方式。方法回顾性分析2002年9月至2011年10月河南省肿瘤医院608例非小细胞肺癌患者行肺切除加系统淋巴结清扫术的临床资料,其中男388例,女220例;平均年龄62.3(45～78)岁。肿瘤位于左肺上叶122例、左肺下叶119例、右肺上叶158例、右肺中叶40例和右肺下叶169例;隆突下淋巴结转移118例(19.4%)。病理类型:鳞癌244例,腺癌285例,其它癌79例。分析隆突下淋巴结转移与肺部肿瘤的部位、病理类型和临床病理特征的关系。结果不同肿瘤部位间发生隆突下淋巴结转移差异有统计学意义(P=0.000),右肺下叶肺癌发生隆突下淋巴结转移比率[45.8%(54/118)]最高;腺癌发生隆突下淋巴结转移比率[55.9%(66/118)]最高,其次为鳞癌(P=0.034)。随着肿瘤T分期的发展,隆突下淋巴结转移的可能性加大,并且左右肺中下叶癌患者隆突下淋巴结转移率大于肺上叶癌患者。结论肿瘤位于左肺或右肺上叶、临床T分期为cT1以内的鳞癌患者,隆突下淋巴结转移的可能性小。
Objective To analyze the modes and rules of subglottic lymph node metastasis in non-small cell lung cancer (NSCLC) so as to explore the surgical approach of subglottic lymph node dissection. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent pneumonectomy plus systematic lymphadenectomy in Henan Cancer Hospital from September 2002 to October 2011 were retrospectively analyzed. There were 388 males and 220 females with a mean age of 62.3 (45 ~ 78) years old. The tumors were located in 122 cases of the left upper lobe, 119 cases of the left lower lobe, 158 cases of the right upper lobe, 40 cases of the right middle lobe and 169 cases of the right lower lobe. 118 cases (19.4%) underwent the lymph node metastasis. Pathological types: 244 cases of squamous cell carcinoma, 285 cases of adenocarcinoma, 79 cases of other cancers. The relationship between lymph node metastasis and location of lung tumor, pathological type and clinicopathological features was analyzed. Results There was a significant difference in lymph node metastasis between different tumor sites (P = 0.000). The rate of lymph node metastasis under the right lung lobe was 45.8% (54/118) The rate of lymph node metastasis [55.9% (66/118)] was the highest, followed by squamous cell carcinoma (P = 0.034). With the development of tumor T staging, the possibility of lymph node metastasis in the subglotal is increased, and the lymph node metastasis rate in the lower and middle lobe of left and right lobes is larger than that in the patients with upper lobe of lung. Conclusion The tumor is located in the left lung or right upper lobe. Patients with squamous cell carcinoma with clinical T stage within cT1 are less likely to have lymph node metastasis under the subglot.