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　　患者淋巴結(jié)狀況分布

　　過去20年間，在探究小病灶肺癌中N0期狀態(tài)的可靠預測因素方面進行了大量研究。然而，一直未能得到測定腫瘤體積方法的清晰闡述，并且對于亞厘米腫瘤患者是否應系統(tǒng)性淋巴結(jié)清掃也仍然存在著爭議。為此，我國上海復旦大學附屬腫瘤醫(yī)院胸外科陳海泉教授與張揚博士等人進行了一項相關(guān)研究，該研究結(jié)果發(fā)表于2012年12月24日的《外科腫瘤學年鑒》(Annals of Surgical Oncology)雜志上。

　　共有243例周圍型非小細胞小肺癌患者被納入了該項研究，研究人員在對新鮮樣本進行甲醛溶液固定之前進行了腫瘤體積測量，并將這些患者的淋巴結(jié)侵犯情況與臨床病理學變量間的聯(lián)系進行考察。并根據(jù)國際肺癌研究協(xié)會(IASLC)/美國胸科學會(ATS)/歐洲呼吸協(xié)會(ERS)最新發(fā)布的肺腺癌分類標準，對患者樣本的腺癌組織學亞型進行分類。

　　研究人員發(fā)現(xiàn)，N1 與N2期淋巴結(jié)侵犯率分別為5.3%以及6.6 %。部分亞厘米腫瘤為N2 期(2/53, 3.8 %)。研究還發(fā)現(xiàn)，鱗狀細胞癌、原位腺癌、微浸潤腺癌、貼壁狀為主的腺癌或浸潤性粘液腺癌均無淋巴結(jié)轉(zhuǎn)移?？傮w而言，該5類細胞占全部周圍型小病灶非小細胞肺癌病例的34.6 %。

　　陳教授等人認為，盡管通過對腫瘤體積的精確測量發(fā)現(xiàn)，腫瘤體積并非N0期狀態(tài)的可靠預測因素。然而，超過三分之一的周圍型小病灶NSCLC仍可通過組織學分類，避免進行系統(tǒng)性淋巴結(jié)清掃術(shù)。

　　Predictive Factors of Lymph Node Status in Small Pe**heral Non-small Cell Lung Cancers: Tumor Histology is More Reliable

　　Background

　　During the past two decades, many studies have sought to find reliable predictors of N0 status in small-sized lung cancers. However, the way of tumor size measurement was usually not clearly stated, and controversy remains as to whether systematic lymph node dissection should be performed in patients with subcentimeter tumors.

　　Methods

　　We reviewed correlations between lymph node involvement and clinicopathological variables in 243 small pe**heral non-small cell lung cancers with their size measured in fresh specimens before formalin fixation. Histologic subtypes of adenocarcinomas were classified in line with the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) lung adenocarcinoma classification.

　　Results

　　Incidence of N1 and N2 nodal involvement was 5.3 and 6.6 %, respectively. N2 disease was present in a proportion of subcentimeter tumors (2/53, 3.8 %). No lymph node metastasis was revealed in squamous cell carcinomas, adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma, or invasive mucinous adenocarcinoma. Collectively, the five cell types accounted for 34.6 % of all the small pe**heral cases.

　　Conclusions

　　Precise measurement of tumor size in fresh tissues revealed that tumor size was not a reliable predictor of N0 status. However, through histologic classification, systematic lymph node dissection might be avoided in more than one third of small pe**heral NSCLC.