Analysis of mediastinal lymph node metastasis of stage cT1a-cN0M0 lung adenocarcinoma
- VernacularTitle:cT1a～cN0M0 期肺腺癌患者纵隔淋巴结转移规律
- Author:
Zhenrong ZHANG
1
;
Hongxiang FENG
1
;
Zhan LIU
2
;
Weipeng SHAO
2
;
Xinlei GU
3
;
Deruo LIU
1
Author Information
1. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, P.R.China
2. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P.R.China
3. Department of Thoracic Surgery, Peking University International Hospital, Beijing, 102206, P.R.China
- Publication Type:Journal Article
- Keywords:
Lung cancer;
adenocarcinoma;
lymph node metastasis;
high resolution computed tomography
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2020;27(10):1187-1193
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the mediastinal lymph node metastasis of cT1a-cN0M0 lung adenocarcinoma, so as to provide a theoretical basis for intraoperative lymph node dissection in patients with early stage lung adenocarcinoma. Methods Clinicopathological features of lung adenocarcinoma patients who received operation in our hospital from 2017 to 2018 were collected. A total of 667 patients including 241 male and 426 female patients at age of 59 (16, 87) years were included. There were 234 patients with pure ground glass nodules, 98 patients with ground glass-predominant tumor, 199 patients with consolidation-predominant tumor and 136 patinets with solid tumor in the study. Postoperative N1 lymph node metastasis occurred in 30 patients and N2 lymph node metastasis occurred in 52 patients. Results The result of univariate analysis showed that male (P=0.014), higher carcino-embryonic antigen levels (P<0.001), larger nodal diameter (P<0.001), larger consolidation tumor ratio (P<0.001), smaller tumor disappearance ratio (P<0.001), solid nodules (P<0.001), cavitary sign (P=0.005), lobulation sign (P=0.002), spicule sign (P=0.003), pleural indentation sign (P=0.001), bronchus sign (P=0.025) were risk factors for mediastinal lymph node metastasis. In terms of pathology, the N2 positive group had larger size of pathological tissue (P<0.001), more N1 lymph node metastasis (P<0.001), higher pathology T stage (P<0.001), more spread through air space (P=0.001), more pleural invasion (P<0.001), and more lymphovascular invasion (P<0.001). Multivariate analysis showed that lymphovascular invasion (OR=6.9, 95%CI 2.3-20.7, P=0.001), larger consolidation tumor ratio (OR=109.6, 95%CI 3.8-3 124.3, P=0.006), cavitary sign (OR=3.1, 95%CI 1.1-8.3, P=0.028) and N1 lymph node metastasis (OR=15.7, 95%CI 6.7-36.4, P<0.001) were independent risk factors for mediastinal lymph node metastasis. Conclusion For lung adenocarcinoma, mediastinal lymph node metastasis will not occur in ground glass nodule and ground glass-predominant tumor patients. The probability of mediastinal lymph node metastasis increases with the increase of solid components and presence of cavitary sign. Therefore, different types of lymph node resection can be considered for patients with different imaging findings.
