Abstract：Objective: To explore the risk factors of lymph node metastasis in cT1aN0M0 lung adenocarcinoma. Methods: The clinical data of 280 cases of cT1aN0M0 lung adenocarcinoma patients admitted between January 2013 and December 2015 in our hospital were selected, and the lymph node metastasis and clinical factors were retrospectively analyzed. The pathological characteristics and clinical data of the patients, single factor and multiple factors analysis were done to explore the influence factors of lymph node metastasis of cT1aN0M0 lung adenocarcinoma. Results: After all the 280 patients with cT1aN0M0 lung adenocarcinoma underwent thin slice CT scan, 108 patients (38.6%) were found to have pure glass opacity in CT imaging. Ground glass opacity combined with solid components (<5mm) were found in 117 cases (41.8%). Ground glass opacity combined with solid nodules (solid component diameter <5mm) were found in 12 cases (4.3%), pure solid nodules (solid component diameter ≥5mm) were found in 43 cases (15.4%). Patients with lymph node metastasis were 28 (10%), of which 16 patients (5.7%) with N1 lymph node metastasis and 12 patients (4.3%) with N2 lymph node metastasis. In this study, all of the patients with a diameter of less than 5 mm in diameter or with pure ground glass opacity, no lymph node metastasis after surgery were found, P<0.05, the difference was significant. Conclusion: For cT1aN0M0 lung adenocarcinoma patients, if the imaging performance were pure grinding glass or solid components of the diameter is less than 5 mm, there is usually no lymph node metastasis occurred. In patients with tumor diameter greater than 1cm, mixed nodules and solid nodules and μg/L CEA>5 were important prognostic factors for lymph node metastasis. Analysis of the maximum standard uptake value in patients with PET-CT showed that patients were more likely to have lymph node metastasis when the maximum standard uptake value was greater than 5(P<0.05).
[1] 朱智军,杨志胤,倪达,等.早期肺腺癌淋巴结转移临床预测因素研究[J].中国医刊,2014,(10):25~27. [2] 王艳芬,刘标,徐艳,等.窖蛋白-1表达与肺腺癌临床病理特征和预后的关系[J].中华病理学杂志,2014,43(4):251~255. [3] 刘英杰,桂淑玉,周青,等.Claudin-18蛋白在肺腺癌所致恶性胸腔积液中的表达及临床意义[J].安徽医科大学学报,2014,49(12):1788~1792. [4] Mattioli S, Ruffato A, Puma F,et al.Does anatomical segmentectomy allow an adequate lymph node staging for cT1a non-small cell lung cancer[J].Thorac Oncol,2011,6(9): 1537~1541. [5] Hashimoto K, Ohtsuka T, Kohno M,et al.cT1aN0M0 lung adenocarcinoma treated with left S9+10 segmentectomy followed by completion lobectomy for a solitarymetastasis (isolated tumor cells) in the neighboring segmental lymph node[J].Gen Thorac Cardiovasc Surg,2012,60 (4): 240~243. [6] Zhou H, Tapias LF, Gaissert HA,et al.Lymph node assessment and impact on survival in video-assisted thoracoscopic lobectomy or segmentectomy[J].Ann Thorac Sur,2015,100 (3): 910~916. [7] 李函阳,方鹤,南钰,等.培美曲塞或吉西他滨联合奈达铂治疗晚期肺腺癌的近期疗效及安全性[J].中国老年学杂志,2015,(9):2433~2435. [8] Matsumura Y, Hishida T, Yoshida J,et al.Reasonable extent of lymph node dissection in intentional segmentectomy for small-sized peripheral non-small-cell lung cancer: from the clinicopathological findings of patients who underwent lobectomy with systematic lymph node dissection[J].Thorac Oncol,2012,7 (11): 1691~1697. [9] 李松,赵芝焕,傅炜萍,等.α-烯醇化酶在慢性阻塞性肺疾病合并肺腺癌患者肋间肌水平的研究[J].中国全科医学,2014,(26):3073~3076. [10] 江昊, 李娈,邓鹏,等.厄洛替尼单药与替莫唑胺联合放疗对肺腺癌伴脑转移的临床疗效分析[J].现代生物医学进展,2014,14(13):2476~2479. [11] 卞春安,李忠佑,许有涛,等.突变型P53蛋白在肺腺癌中的表达及其临床意义[J].中国肺癌杂志,2015,(1):23~28. [12] 喻超,张宇峰,黄斌,等.外周型小结节状肺腺癌淋巴结转移的相关因素分析[J].中国医刊,2014,(4):50~52. [13] Inoue M, Minami M, Shiono H, et al.Clinicopathologic study of resected, peripheral, small-sized, non-small cell lung cancer tumors of 2 cm or less in diameter: pleural invasion and increase of serum carcinoembryonic antigen level as predictors of nodal involvement[J].Thorac Cardiovasc Surg,2006,131 (5): 988~993. [14] 于洋,刘相燕,王洲,等.信号转导与转录激活子3及黏蛋白1基因在肺腺癌淋巴结转移中的作用[J].中华实验外科杂志,2012,29(2):344. [15] 杨欣,张治,胡静雯,等.GPC5基因表达水平与肺腺癌淋巴结转移[J].中华胸心血管外科杂志,2013,29(5):305~307.
2017, Vol. 23 
冀公网安备13080202000677号